Who Do You Trust
Posted Tue, Jan 25, 2011

Who do you trust? Sounds like a great title for a game show or a self-help book. Maybe I will use it someday. Do you trust your broker or financial adviser? Does your 401K self regenerate? Do you trust your banker? Does the bailout of Citigroup and Bank of America resonate? Do you trust a lawyer….? Excuse the pause. I was choking. Do you, can you, trust anyone anymore? Do you trust your doctor?
Today, I am thinking about how to make a decision when a cosmetic surgeon recommends a procedure to improve appearance. Today pediatricians, family docs, gynecologists, dermatologists, facial plastic surgeons, plastic surgeons, dentists, and your hair dresser perform cosmetic procedures and speak with conviction and authority. So you will forgive my cynicism in discounting the vast majority of advice let alone my view of the competence of the vast majority of part-time practitioners of cosmetic surgery.
But then I am still left with a significant number of well qualified cosmetic surgeons who differ in their adv ice for a patient. Sometimes the advice is well intentioned, sometimes the advice is self aggrandizing, and sometimes the advice is personally colored. So what is a patient to do?
The answer must be to look at the aging process. Good nutrition, good sleep habits, and healthy exercise are the most effective deterrents of aging. After that, everything is an attempt to minimize and camouflage the aging face and the aging body. The face consists of various tissues and each has characteristic changes that can be addressed. Skin is subject to sun damage which damages elastic tissue and collagen and causes DNA damage. We see this as static wrinkles, rough skin texture, pigment changes, enlarged pores, and texture deficiencies. If there were a secret cream, a secret anti-oxidant, a secret serum wouldn’t everyone be using it??? Subcutaneous fat and muscle wither with age and cause the skin to sag, the face to narrow, and hollows to appear in the temples, sides of the cheeks, and around the mouth. Bones also reduce in mass and cause the surrounding tissue to sag, the teeth to move inward, the lips to thin and grow long? (Disclaimer- Any impression that this describes anyone I know is purely coincidence!)
So, let’s use a little logic. If the face is collapsed and narrowed and the skin is hanging will a facelift do anything but create another Beattle-juice character? If the cheeks have sagged and involuted and the temples are hollow will 1-2 cc (up to 0.4 teaspoon full) of Restylane solve the problem? If a doctor tells a patient she will have to redo a treatment every 3-6 months did the treatment do anything well applied make-up would not achieve? There really are some answers to these problems but every day I see patients who have been treated by experts who believe one size fits all and either all their patients should be cut or none of their patients should be cut (depending on their training). I will try to address specific problems in coming blogs. In the meantime ask questions, read, and get multiple opinions. Most of all, live healthy.


Edward Lack
Edward Lack MD is a board certified dermatologist and a board certified dermatologic cosmetic surgeon. He is President and Medical Director of MetropolitanMD, a multispecialty cosmetic surgery center in Chicago,which is unique in having a double board certified cosmetic dermatologic surgeon, a double board certified facial plastic surgeon, and a double board certified cosmetic plastic surgeon. Dr. Lack is also the Past President of The American Academy of Cosmetic Surgery.

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