Three Reasons Why There Are More Male Plastic Surgeons Than Female

Plastic Surgery is a specialty that is aimed at wellness and wholeness.  Feeling comfortable in one’s own body is a critical part of holistic health. Women (and men) seek plastic surgery because they are unhappy with some aspect of their physical self. For many women, a female insight into how one relates to one’s own physical presence can improve the chances of achieving confidence with her body.  It is possible that women (not all women) may have an edge on men (not all men) on how this psychology operates, and hence might be better equipped to address the wanted change.  It is surprising how the numbers of female plastic surgeons lag behind, when the great majority of people seeking plastic surgery are female. Here are some stats:

  • 90% of plastic surgery patients are women, according to the American Society of Plastic Surgeons.
  • 50% of medical school graduates are female.
  • The American Society of Plastic Surgery has 758 female members and 4742 male members.  That is a shocking 14%.

So why are there so few women among the graduating medical classes that choose plastic surgery for their career?

  1. First, it’s only been in the last 10-15 years that women have consistently represented half of medical students. Training to become a plastic surgeon is a minimum of six years after four years of medical school so even if half the class is female it is ten years before those women are even able to enter the field of plastic surgery, and another two years to become board certified.
  2. Work-life balance issues are prominent. The hours per week and years of training cut pretty heavily into time for family, friends, and outside interests. If having children is a high priority a choice must be made for women in surgical specialties between hours spent become a skilled specialist or hours spent on maternity leave.
  3. Plastic Surgery is also such a male dominated specialty that many women simply do not want to put up with the sexist subtleties of training. The battle of the sexes is old news, and though there is change that occurs very slowly in women’s position in the workplace, many will pick a different front to address the issues and show their full strength. In other words, they choose a career where the leadership makes them feel entirely welcome, rather than having to struggle with cultural sexism to establishing their worth

The good news is that the women who have chosen the career path to becoming highly trained, skilled, and  certified  by the American Board of Plastic Surgery  are a dedicated and talented bunch!


Botox: Might Be Good for Curing the Blues

40s BotoxDepression may be improved with the use of Botox, according to a report in The New York Times, March 23, 2014 edition. Since Botox can prevent frowning and unhappy facial expression, it was theorized that if you can’t frown it may be harder to be depressed. Researchers wanted to study the idea that facial expressions may feed information back to our brains that influence our mood.

74 patients with major depression received injections in the forehead muscles responsible for frowning. The shots were randomized to either Botox or a salt water solution, placebo. Six weeks later 52% of those who received Botox showed improvement in their depression, as compared to only 15% of those with the salt water injections.

Only half of those in the Botox group were correct in guessing that they had received Botox, which is no better than the toss of the coin. Presumably, knowledge of receiving the Botox could not influence emotional response.

Botox for depression is part of a tradition of “Outside In” therapies that aim to improve the psyche by external manipulations. Acupuncture treatment of anxiety, and exercise for the production of endorphins are other examples of successful use of this methodology. Light therapy sends signals to the brain that can effectively counter Seasonal Affective Disorder. We all recognize that when we look better we have a better sense of self esteem. The concept rings true.

It will take more science to show whether Botox is an effective treatment for depression, and which types of depression it works best for. In the meantime, if you are getting Botox to look a little better, pay attention to whether the absence of frowns puts you in a better frame of mind!

Anti-aging, Beauty, Doctor-Patient Relationship, Facelift, Personal Fitness, Skin Care

JUVEDERM VOLUMA XC: The New Injectable for Improving Cheek and Midface Contour

Juvederm VolumaThe 2013 calendar year saw a whopping increase of 18% in the number of people seeking injectable fillers to smooth wrinkles and enhance contours of the face. There were 1.7 million injection sessions of hyaluronic acid, a naturally occurring substance in all human tissues. The filler contains a numbing agent, lidocaine, so the injection is only a minor discomfort.

Voluma is a  new product developed to be thicker than its cousin Juvederm so it lasts longer.  It is intended to fill in the cheekbones and chin when these start to lose fullness. The FDA approved its availability to Plastic Surgeons in the final quarter of last year and it is becoming readily available.

As the face loses volume and skin begins to lose its elasticity, the cheek bone region flattens and folds of skin develop in the lower cheek from nose to mouth. None of us like it. With Juvederm, the injection is placed into the creases to camouflage the skin relaxing as the volume goes away. With Voluma, the injection is placed in the mid cheek, elevating the nasolabial skin folds to their natural position. With the skilled hands of a Board Certified Plastic Surgeon it can give an immediate improvement in fullness.

Voluma has been used extensively in Europe, Latin America, Canada, the Middle East and Asia since its introduction in 2005. It is finally available here in the US.

Voluma can last up to two years, whereas Juvederm has an average duration of six months. Longer lasting—wouldn’t that be nice? For a low maintenance product and no more upkeep than your skin care routine, you can experience improved facial fullness for up to two years!

Anti-aging, Beauty, Doctor-Patient Relationship, Facelift, Fat Transfer / Fat Grafting, Skin Care

Four Fitness Tracking and Analytics Mobile Apps to Get Your Heart Pumping

These apps offer a tangible way for the body conscious to track calories, monitor steps, and link with friends to stay fit and motivated.  



FitnessPalLogoWhat It Is: MyFitnessPal is one of the fastest and easiest to use calorie counter fitness apps for the iPhone and iPad. With the largest food database (containing over three million food items), the platform is great for keeping track of calories, tracking cardio and strength training and nutrient intake. 

Great Features: You can enter your own recipes and calculate each’s nutritional contents, connect with friends to easily track and motivate each other, and customize weight loss goals based on your specific diet.

Awards: PC Magazine Editor’s Choice Selection and Wired Magazine’s Editor’s Pick for Lifestyle Apps
Cost: Free. Available for iOS, Android, Windows Phone, and BlackBerry.



FitocracyLogoWhat It Is: As the fitness word becomes increasingly social, Fitocracy enables you to join a community of “Fitocrats” who will keep you motivated on your weight loss or get buff journey. This app enables you to track your workouts, earn points, unlock achievements, and if you’re competitive, there’s plenty of that too. 

Great Features:  Fitocracy offers a newsfeed to track friend’s progress and allows you to rearrange workouts, add supersets, circuits, and save routines

Awards: App of the Year by Men’s Journal and Mashable’s Top Innovation in Health and Fitness Winner
Cost: Free. Available for iOS and Android.


Nike Training Club

NikeTrainingClubLogoWhat It Is:  The Nike Fitness app features a collection of visual workouts hosted by celebrity athletes like Serena Williams.  Choose your fitness level and goal, and Nike Training Club picks from more than 100 workouts to get you on the fast track to fit.

Great Features: Nike Training Club features month-long structured programs that’ll help you achieve better results along with 15, 30 and 45-minute workouts featuring audio guidance and video demos from top Nike trainers and athletes.
Cost: Free. Available for iOS and Android.



MovesLogoWhat It Is: Moves is a smart pedometer that records everything from steps taken in a day to miles cycled.  Just carry your phone in your pocket or bag and Moves automatically tracks your everyday exercise.

Great Features: The app’s daily maps and “storylines” give users a new way to easily record and analyze their movement throughout the day, plotting your route on a map and showing calories burned for each activity.
Cost: Free. Available for iOS.

Nutrition, Personal Fitness, Weight loss

The New Breed of Holistic Workout

HealthClubTreadmillsArianna Huffington recently wrote a great article on how exercising (at American health clubs in particular) has become something to dread. Gyms have become a place we drag ourselves to, pay a hefty monthly fee for, and stare at a TV as we clock the obligatory 30-60 minutes/day.

She writes,

“The benefits of making our bodies fitter are deeply connected to the fitness of our inner selves, but gyms make it hard to feel that connection. They don’t allow for the kind of solitude and mindfulness that we can get communing with nature on an outdoor run. And, overly muscled pickups aside, they aren’t very conducive to making any real social connection. A person watching her own screen while walking on a treadmill next to another person watching another screen while walking on a treadmill is like a metaphor for our modern life. It’s what we do at work, at home and at the gym.”

I too find the gym is not conducive to mindfulness, and am more and more conscious that what I am motivated by most, is working out in a social context-with friends or family or the people I work with. I’d rather take a class, or go for a bike ride or a hike and share the endorphin rush with great people, than spend spare hours I don’t have on a treadmill.

Ariana references The Guardian‘s Nicole Mowbray, who wrote recently about the growing trend of the “calm workout,” or “a new breed of holistic workout that promises to care for your head as well as your heart” as she describes it. For example, there’s Psycle, which offers spinning classes in rooms with low lights and calming music and features a “free time” break during the class. 

“The philosophy is supposedly inspired by the belief that ‘your state of mind is key to how often and how hard you exercise.’ There’s also CardioLates, which combines spin and Pilates; Third Space, which offers the services of ‘wellness doctors’; and Spynga, which is part spin, part yoga.

These workouts are part of a trend driven by the understanding that getting fit doesn’t have to be so unpleasant. And it’s pretty simple to see that if we make exercise a more inviting and more rewarding experience, we’ll do it more often. If we’re going to redefine success to include well-being, we also need to redefine getting in shape to include mental and soul fitness.”

View Huffington link

Anti-aging, Exercise, Personal Fitness, Uncategorized, Weight loss

New Primer for Facing Breast Cancer

Madhulika Sikka’s A Breast Cancer Alphabet 

BreastCancerAlphabetFor years, my mornings have begun listening to National Public Radio’s “Morning Edition” broadcast. Madhulika Sikka, news editor for NPR, is a name I have heard regularly as a producer of newsworthy and provocative stories.  When I heard that she had written a book about her experience with breast cancer, my curiosity was aroused to put humanity to her faceless radio presence. I was very pleased by what I found.

Her new book, “A Breast Cancer Alphabet,” is part memoir of her personal encounter with breast cancer, part social commentary about the “Cancer-Land Culture,” and part intuitive self-help advise for any woman facing dark days.


Madhulika describes how each detail of the day she received her cancer diagnosis was stamped on her brain. Sikka was at the White House for an interview with President Obama on the day she was waiting for the fateful call from her doctor.   She talks about the impersonality of having her breasts suddenly become objects of inspection by technicians, residents and doctors.  She calls this both manhandling and “woman-handling” of her private life.  She describes the “I is for Indignities” of mammograms, claustrophobic MRI exams, and special needle localization biopsy where your body has to adapt to the rigid Plexiglas box machine while positioned on your stomach.  

She describes her mastectomy and chemotherapy and how her new diagnosis affected her marriage and her relationships with her children. She describes how losing a breast and losing her hair gave her a different relationship to her body. The rapid change was assault.

“The thing about breast cancer is, it does things to your looks, and not necessarily good things. So, whatever category you fall into–plain or primpedyou find yourself thinking: Why am I so worried about looks right now?”

She recognized that if she needed to look better in order to feel better, “almost like applying a shield.”

Social Commentary

“Cancer-land” was the name she gave to the all-encompassing world of oncology, a land you can never leave once you enter. She was critical of the social pressure to use warrior images of the patient’s treatment endeavor. She disliked the gauzy breast cancer world of pink ribbons and sexy, glamorous warriors fighting back.

“But I am not a woman warrior. I am just a woman, a woman who has been diagnosed with a horrible disease; a woman who has gone through brutal surgery; a woman who has had her body poisoned to “kill” the disease. Can I just be a woman who is going through that? Can I not be a woman warrior? Please?”

Self Help Advice

A Breast Cancer Alphabet is readable, thoughtful and genuine. Her “R is for Reconstruction” chapter  encourages you to think of your reconstructive  plastic surgeon as your very own Michelangelo, who sees each woman’s breast rebuilding as an original artistic creation.Her “T is for Therapy” chapter encourages a variety of ways to heal from the Cancer-Land experience. 

“Therapy is all about healing, and the beauty of healing is that it can apply to your body, your soul, your mind, and your surroundings.

Her writing is beautiful and her word choice speaks to deep reflection on the subject of facing loss in life. Her book is about breast cancer, but is really a healthy reminder of how to respond to many types of dark days, whether they be the result of cancer or not.  

Announcements, Book Review, Breast health, Doctor-Patient Relationship


silicone-vs-saline-breast-implantwebThe American Society of Plastic Surgeons released its 2013 statistics in February. Breast augmentation was again the most frequently performed surgery and 72% of augmentations were with silicone implants compared to only 28% saline. The preference for silicone over saline is a reversal of trends from a decade ago. In the early 1990’s the US had a brewing controversy over the reliability of silicone, and the Food and Drug Association responded with a ban on their use except when part of a safety study. The implants remained available and widely used in Europe and South America. The FDA pre-approval study gathered data for fourteen years before returning the silicone implant to the list of approved medical devices. 2006 was the time of their return to the market, but the product had been modified to address the concerns that were raised. They have come a long way from where they started.    

Silicone implants are generally considered superior today because of their natural feel and durability.  The evolution of the modern Silicone Implant can be summarized:

  • First Generation: (1962) the original implant had a thick shell (0.25mm on average) filled with a thick viscous silicone gel. A Dacron patch was on the back. Implants were controversial when they first came out, but they rapidly became popular.
    Mark Twain once said, “A man with a new idea is a crank until the idea succeeds.”
  • Second Generation: (1970’s) About 10 years later the wall thinned out to 0.13mm and thinner gel was used on the inside. This change was undertaken to create a softer feel.
  • Third Generation: (1980s) A thick, silica-reinforced shell was developed for the silicone implant, to improve the strength of the outer envelope. This generation had much thinner gel content, compared to the thickness of syrup. The gel was more likely to travel when the shell was compromised. These are the implants that generated the controversy of twenty years ago.
  • Fourth Generation: (1992) The shell was made stronger and the gel was more cohesive in response to the problems that had been identified. The cohesive gel sticks to itself and is not likely to “ooze” out if the shell has a break down. 
  • Fifth Generation: (2012) The most recent modification to be approved by the FDA is the “gummy bear” or form stable implant. It has a much denser gel inside and is shaped with greater fullness at the bottom and texturing on the surface. This latest adaptation is being incorporated into practice in special circumstances. It allows more choices to personalize implant selection for each patient.

Twenty years ago silicone implants were held in suspicion. Careful clinical trials were undertaken to confirm their safety. Ten years ago, while the controversy was still brewing, most women chose saline implants for their augmentation.  Our thinking has evolved in response to the scientific data as well as patients’ experiences. The community of Plastic Surgeons will continue to evolve its thinking as new science and technology becomes available.

If ten years from now we are thinking the same as today, it is likely we are not thinking at all

Beauty, Body Contouring, Breast Augmentation, Breast health, Breast Implants, Doctor-Patient Relationship, Mommy Makeover

Plastic Surgery After the Weight Loss: Completing the Process

Massive Weight Loss procedures

The February 2014 edition of the Aesthetic Surgery Journal provides of survey of post weight loss patients, asking which patients were most likely to have plastic surgery to correct the surplus skin issues and which surgeries they preferred to have.

Here are some of their findings:

  1. The majority of patients wanted to have body contouring procedures for both functional reasons and improved body confidence.
  2. People with a weight loss of more than 50kg (110lb) showed a stronger desire for body contouring than those with less than 20 kg(44 lb).
  3. Women were more likely to desire body contouring than men.
  4. Younger age groups had a stronger desire for post bariatric body contouring.

The areas that people most wanted improvement in were:

  • 62.2%. Abdomen
  • 37.6% Upper Arms
  • 28.3% Breast or Chest
  • 35.6% Rear or Buttocks

Only 15.5% did not wish any post weight loss plastic surgery. Most respondents to the survey thought that dealing with the extra skin was an important part of achieving their health goals.

Read more in:
Aesthetic Surgery Journal 2014,Vol 34 (1) 118-132, p. 96.



“BRAVE DAY” March 21, 2014

iStock_000012759589SmallBreast Reconstruction Advocacy Education, sponsored by the Pink Lemonade Project

Breast cancer is an all too common disease. One in eight women will be diagnosed breast cancer. An organization known as “Pink Lemonade” is dedicated to increasing education for women about what their options are for fighting the cancer.

March 21, 2014, BRAVE DAY, has been designated as a day of national awareness of women’s “rights” when it comes to diagnosis and treatment of breast cancer. The Pink Lemonade has declared a Bill of Rights for U.S. Women. It includes:

  1. If you have a family history of breast cancer, insurance companies may provide early screening and preventative measures starting at age 35.
  2. If you notice a lump in your breast, insurance companies will provide access to screening at any age after puberty.
  3. Your first screening mammogram should be at age 40.
  4. If your breasts are found to be dense on a mammogram, your insurance company provides approval for additional diagnostic testing and referral to a specialist to discuss treatment options.
  5. If you have inherited the BRCA gene that puts you at high risk for breast cancer, insurance may provide coverage for preventative treatment.
  6. Insurance covers reconstruction of a breast after either a lumpectomy (partial mastectomy) or mastectomy. 
  7. State and Federal laws require insurance companies to cover reconstruction of the breast affected by cancer as well as a matching surgery for the opposite breast. (Women’s Health And Cancer Rights Act of 1998).

For more information check out


Identical Twin Studies Demonstrate Smoking’s Contribution to Facial Aging

Smoking Twin

The twin on the right smoked 14 years longer than his brother.

Twinsburg, Ohio is the site of the annual Twins Days Festival. The gathering is always a fascinating comparison of “NATURE V. NURTURE”.

The subject of the effect of SMOKING on FACIAL AGING was studied by a group of plastic surgeons who report their findings in the November 2013 issue of Plastic and Reconstructive Surgery.

79 pairs of twins were identified where one was a smoker and the other tobacco free. Over a three year period, standard facial photographs were taken and analyzed by judges that did not know which person was the smoker. Age related facial features and wrinkles were compared and scored.

Those who had smoked more than 5 years had worse scores than their twins in the following ways:

  1. More upper eyelid skin excess
  2. Larger lower lid bags
  3. Large cheek bags, below the eyelid
  4. More upper lip wrinkles
  5. More dark circles on lower lids
  6. Deeper nasolabial folds (the parentheses around the mouth)

The smoke related changes seemed to be worse in the middle and lower face.

Conclusion: A five year difference in smoking can make noticeable difference in features of facial aging.

Are there any good reasons to smoke? 

More than 150 news outlets covered this story including:,, WebMD, Reuters, Huffington Post


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