Chances are you’ve been victimized by the deceptive strategies of the skincare industry. Think about it. How often have you spent money on skincare products that now sit, unused, on your bathroom shelf?

One jar may contain an inexpensive product purchased at the drugstore. You thought it would give you a more youthful look. Another is an expensive cream that promised to tone, nourish, and rejuvenate your skin. Yet another promised to smooth out the crepey skin around your eyes.

No matter the price, they are all sitting on the shelf because they have failed the marketing claims and your expectations.

In the meantime, the cosmetic industry is valued at over 500 BILLION dollars and growing. Its profits are based on false claims and broken promises…at your expense.

Consumers, it’s time to wake up!

The industry is in need of true transparency

Don’t get me wrong. There is a portion of the skincare industry that manufactures personal care products that are effective. These products truly benefit consumers’ health and well-being. Unfortunately, the good actors are drowned out by the marketing frenzy created by the “beauty” industry as a whole. 

This is an industry that – 

  • withholds vital information from the consumer,
  • redefines beauty as a superficial virtue of eternal youth and, all too often
  • offers bogus solutions to skin health.

A large portion of this industry oversells itself. This includes making deceptive claims that neither science nor personal experience can validate.

This industry is in need of transparency…TRUE transparency.

Validating the benefits of skincare products

Science can validate the health benefits of moisturizing the skin. And, many skin conditions improve with the use of moisturizers.

These conditions include –

  • acne
  • eczema
  • psoriasis.

I can say with certainty that many reputable skincare companies manufacture effective emulsions that truly increase the water content of skin. How do I know?

Because I objectively measure the hydration level of the skin surface with an instrument called a Corneometer. This is the same machine that is used by researchers who study skin function. But, right now, it is difficult for consumers trying to decide which moisturizer to buy to know with certainty which one might actually work.

Related content: Formaldehyde: What Is it and What Is it Doing in My Cosmetics

An easy-to-understand rating system that would allow consumers to choose products that truly improve skin hydration and which do not, would be beneficial.

Science can also validate the health benefits of applying daily sunscreen. We know it works for both long term improvement of skin appearance and for prevention of skin cancer.

Unfortunately, there is no validation for the claims of many skincare products. Their ads claim that wrinkles will disappear, age spots will fade, the skin will look younger, and so will you. But, they have no scientific evidence to back up their claims.

The ethical marketing of beneficial products is laudable. But what about marketing that exploits the consumer?

Related Author Content:  Stop Wasting Your Money on These Skincare Products

How we get tricked

Selecting skincare products can be confusing.   And, can even be overwhelming as there are so many of them with so many different price points and claims of benefit. This makes it difficult for the average consumer to determine exactly what they are buying. 

Here are some of the ways we get tricked into buying skincare products:

-Deceptive repackaging

Furthermore, deceptive repackaging practices can add to the confusion. Let’s look at the example of a commonly used moisturizing body lotion found in most drugstores and pharmacies. The manufacturer may repackage it as a moisturizing baby lotion complete with pictures of smooth-skinned smiling babies. Or, it may be repackaged in a very small tube to sell as an expensive hand cream.

The average consumer may not have the chemistry knowledge or interest in deciphering ingredient listings. They are left to rely on product claims, many of which are not validated. How can we say that is in the consumer’s best interest? 

-Seductive claims of anti-aging skincare products

Skincare aisles are stocked with facial products labeled with terms like “anti-aging” and “age-defying.”  Although these facial moisturizers may be beneficial as moisturizers, they’re not “anti-aging.”

They can’t actually change the skin or the law would classify them as drugs as defined by the Food, Drug & Cosmetic Act. And this would require premarket FDA approval.  

Science has yet to discover a single ingredient that can reverse or slow the aging process. Thirty years as a board-certified dermatologist has taught me that wrinkles and grooves of the face cannot be removed by an over-the-counter “anti-aging” cream. Or by any moisturizer for that matter. My colleagues who practice plastic surgery, especially the ones that perform facelifts, are grateful for that!

Related Author Content:  
What You Need to Know About Anti-Wrinkle Creams
Cellulite: A Review of Currently Available Treatments

-The eye cream myth

Is there really a need for “eye” creams? Eye creams are formulated like any other facial moisturizer.

The skin around the eye is no different from the skin on the cheekbone. If a sample of each of these areas is examined under a microscope, a dermatopathologist cannot tell the difference.

Further, if facial moisturizers aren’t formulated safely enough to be applied near the eye, they certainly shouldn’t be applied on the cheekbone, one inch from the eye.

-Night creams that are also day creams

What about those small jars and plastic tubes called “night creams?” You know the ones. They usually contain an ounce or less of the product. And they are often quite expensive.

What would you say if I told you that the ingredients in “night creams” are the same ingredients used in daily moisturizer formulations? Do you really think the skin knows what time of day it is? Is this type of marketing hype fair to consumers? 

-Skincare products you really don’t need

Many of the skincare products sold are completely unnecessary. Exfoliants, masks, scrubs, toners, astringents, and products with “natural” plant-derived ingredients may temporarily feel good on the skin.

However, they lack scientific evidence proving health benefits. Worse, some of them may be harmful and lead to adverse effects, such as excessive drying. Many of these products disrupt the natural life cycle of the skin without bringing any benefit to the user.

Scare tactics and “free-from” skincare products

We’ve all seen display ads proclaiming that a skincare product is “free-from” some particular ingredient. This is usually just a scare tactic employed to imply that the skincare product is now safer because it is “free-from” that particular ingredient.


Parabens are a commonly used class of preservatives that have been researched for decades.

To prevent contamination, all water-based products (which include the vast majority of all facial and body moisturizers) require a preservative. Without one, mold and bacteria would spoil the product in less than two weeks.

Parabens have not been proven to be toxic in human beings when used in approved doses of less than 1%. However, there are stories in the media that attribute negative health effects to the preservative. 

For example, parabens have been accused of being endocrine disruptors. However, their activity as estrogen disruptors is magnitudes weaker than natural phytoestrogens found in foods, including:

  • soy products
  • flaxseed
  • tomatoes–

These are foods that many of us consume every day.

A poorly designed 2014 British study found parabens in breast tumor tissue samples. The author herself clarified that the study never concluded that the parabens caused the tumors.

Media and consumer advocacy groups created a firestorm, perpetuating this erroneous conclusion. This was fake news!

But, it did create a completely unnecessary consumer demand for paraben-free products. The result: a new market segment to exploit.

But an important question remains. It is one that consumers are unlikely to even think of to ask. What alternative preservative is being used in the paraben-free products?

Has the paraben preservative been replaced with DMDM hydantoin, a formaldehyde-releasing preservative (not terrible unless you have an allergy to it or are eczema-prone)? Or is phenoxyethanol or iodopropynl butylcarbamate being used? The safety of these chemicals is not as well documented at that of parabens. That is because they are all less studied alternatives.

-“Natural” skincare products

“Natural” or “chemical-free” products are the fastest growing segment of the skincare industry today. But what do those terms really mean?

First of all, “natural” may imply where the ingredients come from (oils and extracts from herbs, plant roots or flowers). However, it says nothing about the safety or efficacy of that ingredient.  

And it is impossible to sell “chemical-free products” because every ingredient in a skincare product, including those derived from plants, is a chemical.

Further, there is an adage in toxicology: “the dose makes the poison.” It means that it is not the chemical itself that matters. Rather it is the dose or amount of that ingredient within the product.

Water is a chemical. It is a necessary chemical for a healthy body. But drinking 6 liters of water in one sitting can be fatal.

Botulinum toxin is a chemical; it’s also “natural.” Inject 50 units into a woman’s forehead and you can paralyze the muscles so she loses expression. And yes, temporarily, a few wrinkles. Inject 3000 units and she dies from botulism.

Whether claims about a product relate to is benefits or its risks, we need to be transparent. Consumers need to truly understand what they are buying.

-Good for the planet skincare products

More than ever, manufacturers of skincare products are proclaiming to be concerned about our planet. They say they want to be more “green.”

But to truly be sustainable, manufacturers should curtail the sales of products with unnecessary packaging. That includes those tiny little plastic non-biodegradable tubes of moisturizers (regardless of what body part they are marketed for or what time of day they are intended to be used). And, all of the products that are wrapped in separate nonbiodegradable plastic packages that wind up polluting our oceans and seas.

The bottom line when it comes to skincare products

The consumer (and the planet) benefits when fewer confusing, misleading, and unnecessary products are sold.

Skincare manufacturers should engage in trustworthy principled marketing that encourages consumers to purchase beneficial skincare products based on science.

Consumers deserve clear, honest, forthright marketing, without the BS.

We need TRUE transparency. Please!

Breasts have always been a distinctive symbol of femininity. In fact, in many cultures, breast size is regarded as a significant basis of attractiveness and even fertility. Due to their various shapes and sizes, the issue of the right breast size has caught the attention of men and women alike.

Health benefits of breast reduction

Some still believe that bigger is better. However studies have shown that this is not always the case. For example, breast reduction of symptomatic adults and adolescents with macromastia (big breasts) improves quality of life scores.

It has also been specifically associated with improved pulmonary function tests. Further, a recent meta-analysis suggests but does not prove that there may be benefits for women with large breasts felt related to back pain.

What is the right breast size?

In general, breast size is determined by genetics, making it distinct for every woman. And while studies have established the ideal size and proportions preferred by the majority, the way individual women feel about their actual breast size remains to be more subjective and personal than anything else.

The question remains: How do you know if you have the right breast size?

Ideal-Breast-Size-For-Body-Shapes-Dr-Pankaj-Tiwari 650 x 650

Graphic source: Dr. Pankaj Tiwari

Understanding “Ideal” Breast Size

A survey of more than 2000 people pooled data from 1,000 American and 1,000 European subjects about their preferred breast size, comparing it with the standard size in their respective countries.

Results showed that approximately 60% of men and 54% of women agreed that average-sized breasts are more attractive to them. Likewise, 49% of men and 52% of women concurred that a C cup is the ideal breast size, which is close to the average breast size of women in both the United States and Europe.

Further research involving four different countries (Czech Republic, Cameroon, Namibia, and Brazil) showed an outcome that is consistent with the result of the abovementioned survey. While personal liking varies, most of the respondents remained consistent with previous studies, favoring medium-sized breasts over bigger-sized ones.

What’s the right breast size for my body?

Technically, no perfect breast size fits all women. However, there is a breast size that is (or should be) proportionate for a specific body shape. While it may be difficult to assess breast size without the help of your gynecologist or board-certified plastic surgeon, a self-examination of your actual breast can help you determine if your breast size is right for your specific body shape.

There are four standard body shapes, each with a breast size that best complements their overall body proportions.

  • Apple-shaped bodies 

Women with this body shape are often characterized by having a broader waist and lower body. Thus, fuller and sizable breasts are ideal to balance this shape’s proportions.

  • Pear-shaped bodies

Common features of women with a pear-shaped body are their ample hips and defined waist. Moderately-sized breasts complement the full hips and waist, providing a semblance of having an hourglass-shaped body.

  • Hourglass-shaped bodies

This body shape has become a standard form of beauty and is characterized by having a proportional upper and lower body. A small-to-moderate breast size is ideal for this body shape.

  • Rectangle-shaped bodies

As its name depicts, the upper and lower body of women with this shape is uniform; it resembles the hourglass figure without a well-defined waistline. A fuller breast size complements and will add a noticeable curve to a rectangular-shaped body.

What to do if my breasts are too small or too big for my body?

If you are a woman interested in either increasing or decreasing the size of your breasts, there are various surgical and non-surgical options you can consider.

To increase the size of your breast, you can:

  • Adopt a healthy lifestyle 

Having a healthy and balanced diet can make a difference in your breast size. Food rich in estrogen such as chicken, cucumber, cherries, plums, walnuts and those rich in phytoestrogen like soybean sprouts, peaches, and cashews can help in naturally enhancing breast size and promote the growth of healthy breast tissues.

  • Breast augmentation

This surgical option provides the fastest results if improvement in breast size is desired. Breast augmentation involves the use of breast implants or fat grafting in increasing the size of the breasts.

If reducing your breast size is desired, you can choose to do the following:

  • Shed some weight 

Fat is distributed across all parts of the body, including the breasts. Losing weight through a balanced diet and regular exercise can be an effective method as breast fat will also be shed along with overall body fat. It will not only be healthier but also prevents premature breast ptosis or sagging.

  • Breast reduction surgery 

Breast reduction is designed to remove excess breast tissues and fat. And to reshape the breasts into a more desirable profile. It may also be appropriate for breasts that have more dense tissues than fat. As noted above, in addition to decreasing breast size, breast reduction also has other benefits including correcting posture, balancing the symmetry of the breasts, and possibly relieving back pain.

You may also enjoy:
Cellulite: A Review of Currently Available Treatments
How Important is Sleep for Women’s Health?

Myths & fallacies of breast growth

Breast exercises and massages will not enlarge the breast or enhance their firmness. While exercise may affect the muscles in the chest wall, your breast size will remain unaffected by these changes.

Since breasts do not have any muscle tissues per se, they are incapable of being developed the same way as muscles through exercises. Developing muscle mass on the chest may not contribute enough to improve overall breast size.

Related content: 6 Ways to Enhance Female Sexuality While Aging

The bottom line

Breast size has always been a standard of attractiveness when it comes to breast aesthetics. The past decades have seen both men and women favoring bigger breasts. However, this long-standing belief was challenged and disproved with the identification of the ideal breast size

While the ideal breast size is officially determined, plastic surgeons, including myself, are reminding women that they do not need to conform to what is ideal. What’s important is how you feel about yourself and your body. True beauty comes from within. So, regardless of their size, shape, feel, or look, breasts will always be appreciated.


*A survey conducted by pooled data from 1,000 Americans and 1,000 Europeans about their preferred breast size, comparing it with the standard breast size in their respective countries.



This post was first published on July 6, 2018. It has been reviewed and updated for republication on April 14, 2020.

If you have breast implants or have been considering breast augmentation, it’s likely you’ve come across articles warning about a specific type of cancer that impacts those with breast implants. It’s called Breast Implant-Associated Anaplastic Large Cell Lymphoma or BIA-ALCL for short. While being aware of medical developments that may impact you is crucial, this news has inspired fear disproportionate to the number of cases.

Unfortunately, wading through all of the information and studies available can be a little overwhelming.  This leaves many women unsure—particularly when fact and opinion coexist so frequently online. To help you understand BIA-ALCL, I’ve answered some of the most common questions I receive at my practice.

What is BIA-ALCL?

BIA-ALCL is not breast cancer. Rather, it is a form of lymphoma. It helps to first understand the nature of anaplastic large cell lymphoma (ALCL). 

ALCL is a very rare type of non-Hodgkin’s lymphoma – a cancer of the immune system that develops when lymph nodes have a build-up of abnormal T-cells. This is a type of white blood cell that scans for infections and cellular abnormalities in the body as part of the immune system.

Breast implant-associated ALCL (BIA-ALCL) is an even more uncommon form of ALCL. This develops specifically within the scar tissue capsule surrounding breast implants, not the lymph nodes.

How many people have BIA-ALCL?

Since 2010, there have been a total of 660 reports of BIA-ALCL, including 9 fatalities. Because the FDA relies on voluntary medical device reports from physicians and patients, it has been difficult to settle on an actual number of confirmed cases of BIA-ALCL.  It is known that some of the same incidences have been reported multiple times.

As of the latest update in February 2019, the FDA estimates that there have been 457 unique cases of BIA-ALCL, following a comprehensive review of the submitted medical device reports.

In their annual statistics report, the American Society of Plastic Surgeons disclosed that in 2018, their member surgeons performed a total of 313,735 breast augmentations. That is just one year and one reporting body.  Since 2010, millions of breast augmentations have been performed all over the world. Thus the risk of developing BIA-ALCL is likely considerably less than .01% (one-tenth of one percent).

These statistics reflect the fact that BIA-ALCL is very rare. But it is critical for women to be aware of the issue in case they experience symptoms, such as breast swelling, that could be indicative of BIA-ALCL. With early identification, it can be successfully treated with removal of the breast implants and surrounding capsule.

Physicians must educate women with breast implants as well as those who are considering breast augmentation so they can understand fully understand risks and symptoms.

What causes BIA-ALCL?

Frustratingly, we do not yet have a definitive answer to this question. Though we do know enough to make strong hypotheses and caution our patients accordingly.

Researchers are exploring a number of theories to determine what causes BIA-ALCL and working to lower the risk of contracting the disease. The predominant theory is that certain textured breast implants increase your BIA-ALCL risk. Based on the fact that the overwhelming majority of cases of BIA-ALCL have occurred in patients who have, at one point in their lives, had textured implants.

Textured Breast Implants

Textured breast implants are designed with a rough, uneven, silicone gel surface.  This rough surface helps them stick to the capsule of scar tissue that develops, improving stability within the breast cavity.  And reduces the risk of them moving around or becoming malpositioned.

Studies point to implants with a high-surface-area texture, which, for yet unknown reasons, can create an environment that supports the development of abnormal T-cells in the breast capsule. Some specific texturizing processes further increase the risk of developing BIA-ALCL. And make certain styles and brands of textured implants riskier than others.

Are textured breast implants banned?

As of April 2019, the FDA has chosen not to blanket ban all textured breast implants because current data does not show that these devices meet the banning standards outlined by the Federal Food, Drug, and Cosmetic Act. Even though textured implants are still on the market, some plastic surgeons are opting not to place them until more is known, while others have chosen instead to stop placing the specific brands most associated with BIA-ALCL.

While the FDA has not removed all textured implants on the market, they are taking steps to protect patients. On July 24, 2019, breast implant manufacturer Allergan voluntarily recalled all of their BIOCELL textured implants at the request of the FDA, including:

  • Natrelle Saline-Filled breast implants
  • Natrelle Silicone-Filled breast implants
  • Natrelle Inspira Silicone-Filled breast implants
  • Natrelle 410 Highly Cohesive Anatomically Shaped Silicone-Filled breast implants.

Review of incident reports of BIA-ALCL has indicated a much higher rate among patients who have or have had implants manufactured with the BIOCELL texturing process. Therefore, the move to take these implants off the market may be another step toward further minimizing incidences of BIA-ALCL.

If you currently have any of the aforementioned breast implants, the FDA does not recommend removal if you aren’t experiencing any symptoms, given the rarity of the disease. If you have concerns, please contact your primary care provider or plastic surgeon.

Other brands of textured implants are still available to patients

It’s important to understand the role textured implants play and why certain surgeons still offer them. The purpose of a textured surface is to help the implants stay in position within the breast cavity. Often recommended to women with very little natural breast tissue and mastectomy patients, shaped implants are textured as any degree of malpositioning would be easily seen.

Additionally, highly active women may also prefer textured implants (regardless of the specific implant shape) because they are much less likely to be pushed out of the ideal position by muscular movement. For these patients, the small risk of developing BIA-ALCL may be worth getting the benefits of having textured implants.

How do I know if I have BIA-ALCL?

Routine care for women with breast implants

Before I go into the specifics of diagnosing BIA-ALCL, I want to emphasize the importance of routine check-ups of your breast implants. Remember, breast implants are not meant to be lifetime devices.  And as your implants age, your risk of developing certain complications increase, whatever type or style of implant you have.

If your implants are silicone, the FDA recommends patients receive an MRI screening three years after you get your implants and then every two years after that to detect silent rupture.

If you notice anything new or strange with your breast implants, it’s time to schedule an appointment with your plastic surgeon. Even if you haven’t noticed any changes, I recommend booking a check-up around the 10-year-mark so you can make sure all is well.

Diagnosing BIA-ALCL

BIA-ALCL can be tricky to diagnose since certain symptoms overlap with other diseases or cancers of the breast. For this reason, I caution patients to avoid self-diagnosing.


Common symptoms of BIA-ALCL include:

      • Enlarged breasts
      • Chest pain
      • Breast asymmetry
      • Lump in the breast or armpit
      • Skin rash on the breast
      • Hardening of the breast
      • A large collection of fluid (at least a year after surgery, typically after 8-10 years)

When you visit your plastic surgeon with any of these symptoms, he or she will begin with a physical examination of the breast.  And a thorough discussion of your medical history, current health, lifestyle, and history of breast surgery.

–Diagnostic tests

If your surgeon believes your symptoms may indicate BIA-ALCL, they will use one or more of the following diagnostic tests to confirm the diagnosis and determine if your lymph nodes have been impacted:

      • Needle biopsy
      • Drainage of fluid inside capsule/collection of seroma fluid
      • Ultrasound
      • PET-CT or CAT scans
      • MRI
      • Mammography

Once pathological testing and diagnostic evaluation have been performed, you will be notified if you have markers for BIA-ALCL.  And, if necessary, an individualized treatment plan will be developed. During this time, you will likely be working with a team that includes your plastic surgeon, a surgical oncologist, lymphoma oncologist, and/or a hematopathologist.

How do you treat BIA-ALCL?

When caught early, BIA-ALCL is highly treatable—and while those 9 documented deaths are heartbreaking, the risk of it being fatal is very low.

Per the treatment guidelines set forth by the National Comprehensive Cancer Network (updated in 2019) and recommendations from the FDA, both the breast implant and the entire implant capsule should be removed from the body. In some cases, chemotherapy and radiation may be required.

Do I need an en bloc capsulectomy?

“En bloc” means the scar capsule around the implant will be left intact with the breast implant inside and removed as one piece. While the en bloc capsulectomy method requires a longer scar and increases certain risks, I feel it is best for BIA-ALCL patients if the capsule can be removed in this way. This is because cancer cells are present.

That said, the FDA does not distinguish what type of capsulectomy should be used when treating BIA-ALCL. Some patients’ anatomy may make safe en bloc removal difficult or impossible (in which case a total capsulectomy would be used). Because every patient’s anatomy and circumstances are different, implant and capsule removal details are ultimately up to you and your surgeon.

Should I not get breast implants? Should I have my textured implants removed?

Ultimately, this is your decision. While breast augmentation has helped millions of women enjoy a better quality of life and feel more confident with their bodies, it is not a medically necessary procedure. Which means it’s up to you to weigh the risk versus reward.

Speak with your surgeon about your concerns, learn about all of your options, and take some time to think. If you’ve come across this information while researching breast augmentation, remember there is no need to rush to a decision.

For women who currently have textured breast implants, the FDA states that there is no need to adjust your routine medical care and follow-up if you do not present with any symptoms.  And, in fact, they do not recommend prophylactic breast implant removal if you are asymptomatic. That being said, this is your body. If you feel unsure or have found that worrying about BIA-ALCL is impacting your life, talk to your plastic surgeon about your options.

Related Content:  An Innovative Treatment Option for Early-Stage Breast Cancer

How to find more information

I hope you feel more informed about BIA-ALCL after reading this article. However, if you would like to learn more about BIA-ALCL, I encourage you to review the FDA website, which links to a number of studies on the subject.

If you have concerns about your breast implants or suspect something may not be right, please contact your plastic surgeon immediately or locate a board-certified plastic surgeon with BIA-ALCL experience in your area.

Breast Related Article: How Do You Know if You Have the Right Breast Size?


This story was initially published on 6/30/19. It is being republished today (7/24/19) because of breaking news about Allergan’s worldwide recall of certain textured implants.

Following an augmentation mammoplasty, the patient, “Mary Smith”, signed an authorization granting her physician permission to use her “before and after” photographs, with assurances that her identity would not be revealed.

The physician contracted with a medical website development company, which created a website with a photo gallery for “before and after” pictures. The company provided a program that allowed the physician to rename and upload photograph files from his personal computer to his photo gallery. The photo gallery program automatically “scrubbed” all patient identification from the file’s metadata to prevent any breach of identity.

The company also designed a blog as part of the website to increase the number of “hits” and installed a different program that allowed the physician to select and upload photographs from his personal computer to the blog. This program also allowed the physician to change the photograph’s file name to conceal the patient’s identity. However, the blog program did not automatically “scrub” the patient’s identification from the metadata, which also contained the patient’s name. The patient’s identity breach occurred when the physician uploaded the patient’s photographs to the blog.

Although the patient’s name was not displayed when the photographs were viewed on the blog, the metadata still contained the patient’s identification, which meant that an online search for “Mary Smith” would return links to the photos.

A humiliating identity breach

To prevent this identity breach, the physician would have had to manually remove the patient’s name from the metadata on his personal computer prior to uploading the photos to the blog. Unfortunately, the website development company did not inform the physician about the need to change the metadata manually, and it wasn’t mentioned in the instructions provided with the software program.

Internet search engines create and rank search results by scanning (or “crawling”) websites using software called an Internet Bot (a.k.a. web robot) that sends “crawlers” over the Internet to identify new and updated pages to add to their search indexes. When it detects new links on a site, it adds them to its list of pages to crawl. In this case, the search engine identified the source codes in the metadata on the blog, which contained the patient’s name, and added them to the search index with a link to the photographs. When “Mary Smith” was entered into the Internet search engine, her name appeared in the search results. When selected, the link opened to the photographs—even though her name was not visible.


This problem continued for a short time after the photographs were removed from the website because images remain in a search index until the website is rescanned (or “recrawled”) and it recognizes that images have been removed. This may take weeks.

The physician had also placed the photographs on other websites, but no identity breaches occurred because the software on the other sites had automatically scrubbed the patient’s name from the metadata. The patient filed a claim alleging that she had suffered shame, humiliation, embarrassment, anxiety, and loss of sleep.

Related Content:
The Art and Science of Plastic Surgery
Malpractice Claims Study is Helping Plastic Surgeons Get Better

Unintended consequences when working with unfamiliar technologies

This case occurred several years ago, and, considering the logarithmic rate of change in the information technology world, the programming and Internet events leading to this event may or may not continue to be a risk. Although the risk of this particular event may now be reduced because of improvements, it is always important to research healthcare-related technologies thoroughly before implementing them.

If denying access to your website by Internet search engines or web crawlers is an important risk management consideration in your practice, you should research the best ways to block them from your site (e.g., can Internet crawlers access encrypted and password-protected websites?).

This case illustrates the dangers of unintended consequences when adopting new or unfamiliar technologies. The electronic health record (EHR) is another example—The Doctors Company studied medical malpractice claims in which the EHR was a contributing factor and found several risk areas, such as:

  • Point-and-click lists, drop-down menus, templates, canned text, and auto-population of data fields from personalized or packaged templates (for both procedure notes and the history and physical [H&P]) produce redundant, formulaic information that makes it easy to overlook significant clinical information.
  • Frequent drug-drug interaction alerts lead to “alert fatigue”, sometimes causing physicians to override or disable them.
  • EHRs facilitate e-prescribing—which also creates exposure to community medication histories where drug-drug interactions are time-consuming to trace.
  • Templates with drop-down menus facilitate data entry but are often integrated with automated features elsewhere in the EHR, where errors can be easily overlooked and disseminated. If an item is selected above or below the one desired, for example, “qd” can become “qid”.

This post was sponsored by The Doctors Company, the nation’s largest physician-owned medical malpractice insurer.

The number of plastic surgeries performed each year has steadily increased over the years. There were approximately 15.9 million cosmetic procedures performed in 2015 according to the annual report of the American Society of Plastic Surgeons. The top five most commonly performed plastic surgeries included:

  • Breast augmentation
  • Liposuction
  • Rhinoplasty
  • Eyelid surgery
  • Tummy tuck

Read more about how plastic surgeons perform these procedures and what techniques they employ after the procedure to achieve maximum results.


Most popular plastic surgery procedures

1. Breast augmentation

Breast augmentation is the most popular cosmetic surgery performed in the United States. Many women undergo this procedure in order to balance size, restore volume, or for aesthetic reasons. During this procedure, an implant is inserted under the pectoral muscle or behind the breast tissue. Surgeons can make incisions in the crease underneath the breast, around the outer edge of the areola, within the armpit, or above the belly button in order to insert the implant.

There are different implants that can be used in this procedure. Implants are silicone shells that are filled with saline or silicone gel and come in round or anatomic or “tear drop” style depending on the preference and desired outcome of the patient. The size of an implant ranges from approximately 150cc to 800cc. Fat from the body can also be used in a fat transfer as an alternative to silicone implants.

After the procedure, a patient may be sore for the first week. The surgeon may suggest that you wear a supportive surgical bra for a specified amount of time after the procedure to allow for optimal healing.

2. Liposuction

Liposuction reshapes the contours of the body and improves body proportion by slimming and reshaping target areas of the body. The procedure involves making small incisions in order for a thin, hollow tube to be inserted into the skin. The surgeon uses the tube to dislodge fat that can be suctioned out of the body using a surgical vacuum.

Liposuction is commonly performed on the following areas:

  • Thighs
  • Abdomen
  • Back
  • Hips and buttocks
  • Upper arms
  • Inner knee
  • Chest area
  • Chin, neck, and cheeks
  • Calves and ankles

The recovery period may take several weeks. A patient is usually required to wear a compression garment or bandages to help keep pressure on the new body contours and to control swelling.

3. Rhinoplasty

Rhinoplasty is a cosmetic surgery that adjusts the proportions of the nose. While it can be a cosmetic procedure to enhance aesthetics, a rhinoplasty can also help correct deviated septums and other structural defects.

A rhinoplasty can be performed as a “closed rhinoplasty” or an “open rhinoplasty.” During a “closed rhinoplasty,” surgeons make incisions inside the nose, hiding them completely. In an “open rhinoplasty,” a surgeon makes an incision across the skin separating the nostrils, called the columella. Once an incision is made, either inside or outside the nose, surgeons adjust and reshape bone and cartilage to create a desired shape and look.

After a patient undergoes a rhinoplasty, they typically wear a nasal splint for the first week of recovery. Swelling and bruising may last until a few weeks after the surgery.

4. Eyelid surgery (blepharoplasty)

Eyelid surgery involves removing or repositioning excess skin and fat from the eyelids in order to improve obstructed vision or to enhance aesthetics. This surgery can be performed on the upper and the lower eyelid. A surgeon typically makes incisions in the natural creases of the eyelid to reduce the appearance of scarring after the surgery.

A double eyelid surgery can also be performed in order to create a more defined eyelid line. This procedure is the most common plastic surgery procedure in South Korea.

Patients may experience symptoms including dryness of the eye, swelling, and bruising for a short while after the procedure. Patients may also be given a cold compress to help treat these symptoms.

5. Tummy tuck (abdominoplasty)

A tummy tuck tightens the abdominal area to create a slimmer overall appearance. Surgeons remove excess skin to create a flattened and toned midsection. There are several options for tummy tucks ranging from mini-tummy tucks to full tummy tucks.

Mini-tummy tucks involve a single, horizontal incision through which surgeons tighten muscles and remove excess fat in the lower belly. However, during a full tummy tuck, a surgeon makes a longer incision that runs from hip to hip and improves the upper and lower abdomen.

After this procedure, patients wear an abdominal support garment. Doctors may insert surgical drains to drain liquid from the site of the procedure. Your surgeon may also encourage you to walk around during the first few weeks in order to help ease swelling.

Related Content:  5 Signs You’re Not Ready For Plastic Surgery

How surgeons reduce scarring after plastic surgery

These plastic surgeries would not have the same impact if postoperative scarring was prominent and visible. Certified plastic surgeons employ many methods during procedures to reduce the appearance of scarring. However, the effectiveness of these methods depends on the age of the patient, the size of the incision, the patient’s genetics, and the tone of the skin. Read about some of the techniques that surgeons use to reduce scarring.

Scar location

Plastic surgeons receive training on how to hide scars. They are aware of which areas of the body are likely to scar poorly and which areas will heal better to hide scars. Eyelids and facial areas heal well and often hide scars. Other areas, however, like the back, shoulders, joints, and breastbones may result in dark, thick scar lines. Although no scar from plastic surgeries can be completely invisible, most scars heal nicely over time.



Plastic and cosmetic surgeons have much experience in careful handling of body tissue, especially when it comes to placing sutures. They typically use smaller sutures that are placed under the skin or sutures that will absorb into the body in order to reduce potential scarring. Using sutures that absorb into the body avoids the need for suture removal and external marks.

Post-op care

For many of the procedures mentioned, plastic surgeons may prescribe medication, instruct patients to avoid sun exposure and to rest for an allotted period of time. Doctors may also use draining tubes, surgical bras, and fresh bandages to help speed up the recovery process. In many cases, patients will also be asked to avoid strenuous activities and vigorous exercise to allow the body to heal properly.

In many aspects, this extreme care and attention to detail required in plastic surgery make this profession an art and not just a science.

With the recent popularization and widespread acceptance of cosmetic surgery, I’d like to caution readers about making the mistake of rushing into plastic surgery too soon. Popular media abounds with stories of celebrity plastic surgery, making the process seem as easy as, say, changing one’s shoes. Having plastic surgery may seem innocuous and an endeavor easy to undertake, but it is still real surgery with real risks and has long term effects.

It is called plastic “surgery” for good reason. The surgeon will make an incision with a knife that will leave a permanent scar (albeit one that is very well hidden) and will dissect around blood vessels, nerves, and organs. While most often this is done on healthy people, with a very successful outcome, troubles can still arise. This is especially true if performed by someone less than qualified to perform your desired procedure.

Plastic surgery is an endeavor that can bring about positive life-changing results and have long lasting effects on your body, your mind, and your emotions. However, not everyone is ready for plastic surgery. Not everyone has thought through their decision fully. Below is a list to help those who might be questioning their readiness for plastic surgery. Below are 5 indicators that may mean you are not quite ready for this transformation:


5 signs suggesting you are NOT ready for plastic surgery

  1. You decided yesterday. You were out for drinks with your girlfriends and you decided you don’t like the size of your breasts. Your bust size never really bothered you before. But now, you are analyzing your friends and comparing yourself to them. You think “it might be fun to have a boob job”.
  1. Your husband is having affair. You look at his secretary and try to compete with someone 20 years your junior. Having surgery in order to “compete” with someone is NEVER the right answer. Surgery should be something you’ve thought about for a significant period of time and because you want to change something that YOU don’t like. Plastic surgery to try to be someone different is NEVER a good reason.
  1. You are currently pregnant. While this wondrous joy of growing a life inside you is something special, the increase in hormones can make your thinking “not so straight”. Emotions run pretty high during pregnancy, especially in the later trimesters when the physical alterations can be at their peak. In my office, I always encourage women to wait a while before considering plastic surgery. If a mom is breastfeeding, I encourage her to wait at least three months until after the time she stops breastfeeding for her body to get back to a “normal” state. The breast swelling takes a while to go back down to the “native” state after pregnancy and breastfeeding alterations.
  1. You have not completed your full growth. Many times, young people will inquire about altering a body part with surgery. When in reality, just the “tincture of time” prescription can alleviate any concern. Different body parts grow at different rates. Prime examples are noses, ears, and breasts. Noses or ears that don’t seem to fit the body will actually look quite normal once the rest of the body catches up. Asymmetries to the breasts and body oftentimes equal themselves out with a little bit of time and patience.
  1. You are graduating or accomplishing a major milestone in your life. While this may be a time in your life to celebrate, that celebration shouldn’t involve plastic surgery. This is real surgery and makes “real” changes in your body with long-lasting effects. Unlike having a champagne toast or a celebratory cigar, plastic surgery can be life and image altering with lifelong effects, that oftentimes cannot be reversed. Plastic surgery is NOT something to enter into flippantly or lightheartedly. It should be a deliberate decision consciously and thoughtfully thought through. However, if you have set a goal to achieve something (like weight loss or finishing your Master’s degree, for example) before rewarding yourself with a long-desired procedure, plastic surgery may be a good motivator to accomplish that goal. As long as this has been carefully considered, using plastic surgery as your reward may be a perfectly acceptable reason.
  1. BONUS: You are trying to keep up with a fad. I know I listed only 5 in the beginning but with the “Gotta have it now” lifestyle that seems so prevalent today, I felt impelled to add this last one in. Styles in beauty change rapidly. Plastic surgery is not like changing shoes or altering hair color. Undergoing surgery in order to keep up with a fad or trend is not recommended. The fads will change or fade and your results will continue on, or worse, could lead to problems (like additional breast drooping from too large an implant placed) or require additional surgery in the future. One recent example has been with breast augmentation surgery. Going back to the 1980s and continuing to as little as a few years ago, the trend for augmentation was to go as large as possible. That was the attractive style/standard. Now, with improved technology of the implant and the surgical techniques used, a more conservative augmentation has become the more desired outcome.

Surgery can irreversibly change your body. Give it some thought before you rush into this. An additional thought that should also be entertained when considering plastic surgery is “How will this affect you and your style many years down the road?”

Plastic surgery has certainly become more mainstream in recent years. It is safer, more affordable, and techniques have advanced so as to lessen the downtime. It is still real surgery with real effects, some of which can be life altering, usually for the better. As you see from above, it should be entered into after careful consideration and after having a full education about the procedure desired. With proper thought and appropriate planning, undergoing plastic surgery can be a great decision.