Health Leader, Gilding the Lilly

STORY BY

Shannon Rasp

Once upon a time, plastic surgery and so-called “cosmetic” procedures were never mentioned in polite company. Clients, mostly women, would disappear for a few weeks on “vacation,” come home remarkably rejuvenated, and everyone would pretend she’d just gotten some well-deserved rest.

Those days, however, are gone. The health care industry has seen a dramatic surge in requests for esthetic procedures, and not just from wealthy patients. Increasing numbers of middle-class women and men alike, are fueling demands for this type of care, and they see no reason to hide it.

Unfortunately, that changing attitude has also contributed to a growing number of unqualified and unskilled people performing this work. So what should a person look for when contemplating esthetic procedures?

Dermatologic procedures

First, it’s important to decide what procedure will work best for your particular needs. When we think of esthetic procedures, plastic surgery often is the first thing that pops to mind. But that is only one of the options available today. Dermatological procedures cost less, have a shorter recovery time, and can achieve amazing results.

More and more dermatologists are branching into cosmetic dermatology, which includes procedures such as microdermabrasion, chemical peels, laser treatments, Botox, and sclerotherapy. These can improve the skin’s appearance and elasticity, smooth out wrinkles, lessen the appearance of veins, and often erase years of sun damage to the skin. It’s important to realize, however, that the person performing these services must be properly trained.

Ask questions!

“People contemplating dermatological procedures need to do their homework first,” says Asra Ali, M.D., assistant professor of dermatology at The University of Texas Medical School at Houston. “Ask questions like ‘How long have you been doing this procedure? What have your results been? If there is a complication, are you qualified to deal with it? Are you board certified? Do you have before and after photos?’ Plus, people need to discuss with their providers what type of procedure to have, what results will be realized, and how that procedure will be tailored to their specific skin."

For instance, the fair-skinned require a different solution mix in their chemical peels than darker-skinned persons, and 50-year-old skin reacts differently to certain procedures than teen-aged skin.

Weight reduction surgery

For some people, the problem isn’t the appearance of their skin, but the sheer amount of it. The increasingly popular bariatric surgery, which reduces the size of the stomach of the morbidly obese is a sophisticated procedure that demands highly-trained surgeons and a clear understanding of the pre- and post-operative restrictions.

“Choosing a ‘competent provider’ is always a complex issue, since there is a reluctance on the part of patients to ask relevant questions about a surgeon’s education, experience, results, and opinion as to whether there are reasonable alternatives to the surgical procedure for which they are seeking advice,” says Frank Moody, M.D., professor of surgery at UT Medical School at Houston.

“Patients must be fully informed about the risks and benefits of bariatric [weight reduction] surgery before seeking consultation. They should listen very carefully to the advice of their primary care physician,” Moody adds.

Most patients have indeed done their homework, Moody says, since there is so much information on the Internet and in the media.

Patients should beware of advertising, though, which has gained in popularity even with the most ethical of surgeons. “What you see is not necessarily what you get.”

Moody says that bariatric patients require an entire team of trained health care professionals to manage them before, during and after their surgeries. For that reason, he recommends they seek out bariatric centers that specialize in these techniques. “The surgical intervention is only a component of the comprehensive treatment for this complex disease. Nutrition, exercise, and behavior modification techniques are all required care.”


In the case where the teeth are misaligned, we did "non-orthodontic tooth straightening". We first bleached the uppers and lowers, then did eight porcelain veneers on the upper centrals, laterals, cuspids, and first premolars to improve the arch form and appearance of the teeth.

Cosmetic Dentistry

Cosmetic dentistry is rapidly gaining in popularity as an esthetic choice and the multi-million dollar tooth-whitening industry is just one such tool. Dentists now have an array of products that will improve patients’ smiles – veneers, crowns, caps, composite restorations, and inlays.

“Cosmetic dentistry is not really a field by itself – it is an integral part of general restorative dentistry,” says Rose-Marie Fay, D.D.S., an assistant professor of restorative dentistry at The UT Dental Branch at Houston. “Restorative dentists should be just as concerned with restoring or improving the esthetics of the smile as he or she is with restoring teeth so they can properly function.”

Fay says that since there is no “cosmetic dentistry” specialty, dentists possess a wide disparity in training – that’s why it’s important for consumers to do their research.


In the second case with tetracycline stains, we also bleached first (I usually always bleach first before veneers to get the best base shade possible) then restored with eight porcelain veneers on the upper centrals, laterals, cuspids, and first premolars; then also six porcelain veneers on the lower centrals, laterals, and cuspids.

Like Moody, Fay says that she would not feel comfortable going to a provider simply because they list themselves as cosmetic specialists in the Yellow Pages, or have a sign reading “cosmetic dentistry.”

She believes that Web sites are actually valuable in helping to narrow the field, because they usually have information about the doctors, their training and experience, as well as professional organizations to which they belong, such as the American Academy of Cosmetic Dentistry.

“I also wouldn’t go to a provider just because they are the least expensive,” she adds. “You aren’t just paying for a crown or some veneers. You are paying for the service a true expert provides, which is a combination of experience, selecting the best materials for your situation, and taking the time to provide excellent treatment.”

Fay believes that the best advertisement for a cosmetic dentist is a satisfied customer. She suggests asking those with nice smiles if they have ever had any treatment. “This may be a little hard for some people, because they are concerned about others knowing they are seeking this type of treatment, but they should be brave! This is, after all, a vital aspect of their appearance.”

Once the patient selects a dentist, they should ask the provider if they can see before and after photos of some of their procedures. After a thorough examination, the dentist should be able to answer questions to a patient’s satisfaction. “It’s important to feel as if you and your dentist are on the same page regarding the result you want to attain,” she cautioned. “If you don’t feel this way, it may be a good idea to try someone else.”

Being Picky Pays Off

It’s best to be choosey about the type of esthetic procedures you have – not only for the health and wellbeing of your body, but also of your wallet. Most cosmetic or esthetic procedures are not covered by medical insurance, which means paying out of pocket.

Medical procedures aren’t cheap, either – caps on teeth can cost hundreds of dollars per tooth; dermatology treatments can run hundreds of dollars per visit. Bariatric surgery, however, is an exception. Under certain conditions, medical insurance will pay a portion of the costs incurred. This usually requires a written letter from a doctor verifying the medical necessity of the procedure, pre-certification, and other materials.

If a treatment is deemed “reconstructive,” that is, repairing a part of the body that has been damaged in the past, it can also be covered by insurance. It is important to call your medical insurance carrier before visiting any medical professional and asking what a specific policy covers and in what circumstances.

Esthetic procedures are serious health care choices, and should be approached as such. Experts agree that a healthy dose of consumer homework and legwork will yield the best results.

UPDATED: 4-24-2003