A view of Oz from the Emerald City

In case you didn’t know, we denizens of Seattle refer to our metropolis as the Emerald City, though mossy green would be a more apt label for the color chip. So picture my plastic surgery clinic here as a scene from The Wizard of Oz, when Dorothy and her companions first enter the wondrous city: snip snip here, snip snip there, and a couple of tra-la-la’s …
OK what this is really about is Dr. Oz, of Oprah fame, and his “real age” website that allows you to calculate your functional age based on your diet, exercise, and other lifestyle patterns. I have to admit that I have always been attracted to the idea, but their follow-up recommendations always seem to include vitamin supplements, which have been widely disproven to have any anti-aging benefit in the context of a normal diet. To their credit, they seem to have toned this down since I first checked them out a couple of years ago. Maybe they actually read some of the references I sent them, though they didn’t seem particularly eager to have their philosophy challenged, especially at the interface where vitamin sales produce revenue.
So now Dr.Oz is on the resveratrol bandwagon, selling his own brand of this compound from red wine that has gained so much attention as a potential anti-aging intervention. (CBS TV’s “60 minutes” reran their update on this on May 24th.) It is true that with more than 2400 scientific articles on resveratrol, a pretty strong case is made for its use; I have added an entire chapter on resveratrol to the second edition of my book “Age Gets Better with Wine: New Science for a Healthier, Better, and Longer Life” due out in July from the Wine Appreciation Guild press. Impressive results in lifespan extension and disease reduction in a variety of laboratory animals have been reported and resveratrol has practically become a household word. You can even find resveratrol pills at the vitamin section at most supermarkets now.
There is, however, one small problem: To date, no clinical trials of resveratrol supplementation in humans have been reported in peer-reviewed literature. In other words, the use of resveratrol supplements is as unproven as teleporation by clicking your heels together three times. A lot is still unknown about what actually happens to resveratrol after oral ingestion; what is known is that it is rapidly metabolized and altered. Clinical trials are underway, and there are reasons to be encouraged, but as of now that is all we have to go on.
It’s a gamble for Dr. Oz. If his support of resveratrol turns out to be a good idea, he will look like a wizard. (I do feel obligated to point out here that I was talking about this several years ago.) However, if it turns out to be less than miraculous in humans, he may well go the way of Linus Pauling, who staked his considerable reputation on vitamin C mega-dosing. In case you haven’t heard, it didn’t really work out.

It's a team effort

Plastic surgeons are generally not known for humility (or understatement I suppose). We are certainly fortunate to be in a unique position, one which is personally rewarding and when done for the right reasons, a benefit to our patients as well. While some dismiss our occupation as catering to the vain, we do help people to lead better lives. You get the point if you have been following my recent posts.
What I want to focus on in this post is the team of people who help it all to happen. To begin with, no matter how much talent a person has, they need teachers who have the interest and special capability to help others along. (When people note the expense of surgery, I explain that they aren’t paying for the couple of hours the operation takes, but the thousands of hours of training and education that precede the event.) It takes a generous spirit to mentor others.
Then of course there is the staff who assist me directly. If they don’t have a caring attitude and dedication, then the patient doesn’t have a good experience no matter how technically successful the surgery may be. I am fortunate to have long-term staff, a few of whom will have been with me for 10 years this summer. Our repeat patients, who may have gone several years between procedures, comment on how great it is to see the same faces when they come back.

Botox, Re-lox, black box; new toxins, new controversies

Pop quiz: What do Botox, Xerox, Kleenex, and Clorox have in common (besides alliteration)? The answer is they all are brand names that are interchangeable for the product itself. True, we most often say “photocopy” now instead of Xerox, but it is still common to ask for a Kleenex instead of a “facial tissue,” no? Similarly, Allergan’s Botox has become synonymous with Botulinum toxin type A, and the brand celebrates its 20th anniversary since FDA approval. But the FDA welcomed a new member to the family with yesterday’s approval of Dysport from competitor Medicis, best known for the popular wrinkle filler Restylane.

But as we have come to expect from our friends at the FDA, what the one hand gives the other takes away. Both products will come with what is called a boxed warning regarding potentially serious side effects. Given that there is a 20-year record of remarkable safety for Botulinum toxin, why the sudden concern? You can thank Ralph Nader’s misguided lobby, Public Citizen, which a year ago petitioned the FDA to look into reports of adverse reactions from Botox. These are of course the same people who stirred up all the trouble with silicone breast implants, which were completely vindicated in scientific studies.

Is there really a safety issue with Botulinum toxin? Most people know it only as a wrinkle reducer, which requires tiny doses and is harmless when properly used. But at least half of the market for this product is to treat spastic muscles associated with such conditions as cerebral palsy, which requires large doses, often in children, and a much greater potential for side effects. But the good that is done, improving quality of life for thousands to millions by increasing mobility for the disabled to preventing migraine headaches needs to be taken into consideration. The FDA’s acting deputy director of the Office of Drug Evaluation stated that “we don’t mean in any way to discourage” the use of these products, but given the way these things are misinterpreted by a public primed for panic, it rings hollow. I do take the FDA’s guidance seriously, I just want them to acknowledge and take seriously the political influences under which they operate.

Whether the new product will carve out a slice of the market remains to be seen. There are some subtle differences between the products from Allergan and Medicis, but clinical experience will tell if these are important.