Plastic Surgeons Respond to Proposed Cosmetic Surgery Tax

Surprise Addition to Healthcare Bill is Arbitrary, Difficult to Administer

Arlington Heights, IL and New York, NY – Democratic leaders in the Senate unveiled their proposal for overhauling the health care system, which included a new 5% tax on elective cosmetic procedures. Senate Democrats argue that the tax, which was a surprise addition to the sweeping 2,074-page bill, will generate $5.8 billion over the next 10 years to be put towards the bill’s estimated $849 billion price tag. However, the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) oppose this tax as discriminatory, arbitrary and ineffective.

“Elective surgery taxes discriminate against women, given that 86 percent of cosmetic surgery patients are female, of which 91 percent are between the working ages of 19-64,” said Michael McGuire, MD, ASPS President. “Moreover, contrary to popular belief, cosmetic surgery is no longer an exclusive luxury afforded by the very wealthy, but rather a mainstream and reasonable option most common amongst the working middle-class.”

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American Academy Of Cosmetic Surgery Opposes Cosmetic Surgery Tax

Chicago, IL – As negotiators on Capitol Hill try to find ways to fund a health care overhaul, a 5% tax on cosmetic surgery has been introduced on Nov. 18 as part of the Senate’s proposed health reform bill, introduced by US Senator Harry Reid (D-NV). The American Academy of Cosmetic Surgery strongly opposes such taxes and urges legislators to consider the following points:

• A tax on elective cosmetic procedures is an unreliable, risky revenue source that has no proven record of raising projected revenues.
• The difficulty of defining elective vs. medically-necessary cosmetic surgery. There is a blurry line between what procedures are considered medically-necessary and those that are elective.
• Retention of highly-skilled physicians is at risk. Physicians face many challenges in operating their practices on a day-to-day basis. Turning them into tax-collectors is an additional burden on these doctors.
• Cosmetic surgery is not a specialty for only the wealthy or the vain. In fact, the median income for those electing to have cosmetic surgery is dropping.
• Despite the fact that more men are seeking cosmetic procedures than ever, the largest portion of patients are still working women, who would be unfairly targeted by such taxes.
• A large portion of those being taxed would be the baby-boomer generation. And as this age group continues to age, the more interest will be generated in cosmetic procedures. It is important to note that the age bracket are most likely to vote in elections is the same as those who are electing to have cosmetic procedures.

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Nasal Plastic Surgery: Rib Cartilage Grafts Results in High Patient Satisfaction

Chicago — Rib cartilage from human donors is well tolerated as a grafting material in nasal plastic surgery and yields positive functional, structural and cosmetic results, even in complex cases, according to a report in the November/December issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.

“The search for the ideal nasal implant remains an ongoing effort,” the authors write as background information in the article. “We desire a substance that is readily available in large quantities; resists infection and absorption; is completely integrated into host tissues; causes little patient morbidity [illness or injury]; and can be molded, shaped or carved with ease.” The patient’s own cartilage is often the preferred choice, but is sometimes too thin, there is an insufficient quantity or it may cause problems at the site from which it is removed. Irradiated homologous costal cartilage—donor tissue from human ribs that has been treated with radiation to decrease the chances of an immune response or resorption once placed in a donor—could serve as an alternative.

Russell W. H. Kridel, M.D., of the University of Texas Medical School at Houston and Facial Plastic Surgery Associates, Houston, and colleagues reviewed the medical charts of 357 patients who underwent primary or revision rhinoplasty (nasal plastic surgery) using autologous costal cartilage as the principal graft material between 1984 and 2008. The patients were an average of 37 years old and were followed up for an average of 13.5 years (and for a range of four days to 24 years). The 1,025 homologous costal cartilage grafts and 373 other grafts used were evaluated for warping, infection, resorption (being absorbed back into surrounding tissues) with or without infection, mobility and extrusion (forcing out). Forty-two patients also completed a satisfaction evaluation.

The total complication rate related to irradiated homologous costal cartilage grafts was 3.25 percent, including 10 warped grafts, nine infections, five cases of infective resorption, five non-infective resorptions and three cases of graft mobility. Among the nine cases of infection, two patients received grafts using homologous costal cartilage alone and seven in combination with other materials, so the infection rate related to the use of homologous costal cartilage alone was two of 1,025 (0.2 percent).

“Not only did very few complications occur following the use of 1,025 irradiated homologous costal cartilage grafts in 357 patients after 386 rhinoplasties over 24 years (rate, 3.25 percent), but the rate of complications was no greater than rhinoplasty complication rates when autologous [the patient's own] cartilage grafts are used,” the authors write.

During an average follow-up of 7.9 years, 94.2 percent of patients reported being satisfied with the results, considering categories such as their appearance, ability to breathe and quality of life. The irradiated homologous costal cartilage was not associated with any allergic reactions or systemic diseases and also proved to be reliable in patients with autoimmune diseases and in those with complex cases involving repairs of perforated septal tissue.

“The results indicate safety and reliability and justify the convenient use of irradiated homologous costal cartilage grafts for primary and revision rhinoplasty without creating donor site morbidity,” or damage to the area from which an individual’s own cartilage is harvested, the authors write. “Irradiated homograft cartilage grafts should be considered as an alternative or even a primary grafting material when the patient does not have adequate quantities of septal or auricular [ear] cartilage remaining to provide the correction or when the shape or quality of such an autologous cartilage does not adequately provide the structure required.”

Source: JAMA and Archives Journals

For more information about nasal plastic surgery don’t hesitate to contact us.

- Before and after rhinoplasty

Today’s Economics of Fertility Treatment

Atlanta, GA – Since the beginning of the current economic downturn, everyone has been wondering how new financial considerations and constraints are affecting the decisions people make about a variety of reproductive medicine procedures. While there have been no national data collections, researchers have been evaluating their own clinics’ data and local data to arrive at some answers.

Many have speculated that more women would turn to compensated egg donation to try to supplement falling incomes and net worth in the downturn. To either confirm or disprove the reality of this phenomenon, researchers at Reproductive Medicine Associates of New York and Mt. Sinai School of Medicine undertook a comparison of egg donor applicant characteristics from the 2002-2004 time period and 2008. Fifty-four interview records from 2002-2004 and 46 records from 2008 from a single private oocyte donation program were reviewed and compared. During both periods, the same person conducted the interviews and the same questionnaire was used. No significant difference was found in the applicants’ demographic characteristics. The age of prospective donors, their history of previous donation cycles, their education level, marital status, distribution of religions and religiosity remained consistent from the earlier period to the later. The largest difference to emerge was in the donors’ plans for use of their compensation. In 2002-2004, 28% planned to use the money to pay for schooling. This increased to 57% for 2008. Differences in other planned uses for the money were smaller: from 2002-2004 to 2008, the number of women planning to use their compensation to pay debt decreased from 32% to 21% and the number planning to save the money decreased from 20% to 11%.

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Lap band surgery effective for morbidly obese children

In FDA-approved trial, adolescents had 45 percent weight loss two years after surgery

Washington, DC — A surgeon at Children’s National Medical Center and his colleagues from New York University have found laparoscopic adjustable gastric banding (Lap band) to improve the health of morbidly obese adolescents.

The study, published in the Journal of the American College of Surgeons, involved nearly 50 girls and boys ages 14-17. The participants showed significant decreases in total and android fat mass 2 years after surgery. Android fat has been linked to the development of obesity-related illnesses, such as diabetes, heart disease, and insulin resistance.

“This study is the first to demonstrate the improvements in overall health and distribution of weight loss after Lap band surgery in adolescents,” said Evan Nadler, MD, the lead author and pediatric surgeon at Children’s National. “While weight-loss surgery should always be a last resort for adults and adolescents, these findings show us that surgery in adolescents reduces the risk of significant health complications.”

The study found that Lap band surgery improved glucose metabolism, reducing the adolescents’ risk of developing insulin resistance. Additionally, bone mineral density was not impacted by the surgery, suggesting that bone growth is not affected.

Dr. Nadler is the co-director of the Obesity Institute at Children’s National Medical Center, which is comprehensively addressing the epidemic of childhood obesity. Staff includes pediatricians, nutritionists, psychologists, cardiologists, gastroenterologists, and surgeons who treat patients and families in a clinical setting. The Obesity Institute also includes researchers looking at genetic differences and racial disparities, particularly among children and adolescents, as well as community-based research among different ethnic groups.

Dr. Nadler was an investigator for Allergan, which makes the device used in the study. Funding was provided by the Harris Obesity Prevention Effort at New York University and performed at NYU Medical Center.

Source: www.childrensnational.org

First-of-its-Kind Study Links Breast Reduction to Reduced Back Disorders

According to new research presented at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2009 conference, Oct. 23-27, in Seattle, women who have breast reduction surgery may be at a decreased risk for spine and other back disorders. Macromastia (overly large breasts) can be an unhealthy condition resulting in significant shoulder pain, back pain, and deep shoulder grooves caused by bra straps. In the study, women who had breast reduction experienced decreased stress in their lower back while performing a physical activity or task. In addition, participants reported dramatic improvements in their ability to perform dynamic movements and withstand static positions. To gather the results, eleven women, determined to need breast reduction surgery, participated in a biomechanical analysis/task that involved lifting a 5 lb. weight and responded to a questionnaire prior to and following their surgery.

By the Numbers:

According to ASPS statistics, nearly 89,000 breast reductions were performed in 2008, up 5 percent since 2000.