he facial plastic and reconstructive surgical field is constantly changing. The successful surgeon will not only keep stride with those changes but will embrace them without abandoning their core characteristics of excellence.
Having been in practice for well over 15 years and completing extensive technical training in otolaryngology – head and neck surgery as well as facial cosmetic surgery, I’ve learned that integrity remains the foundation for a successful career. Toward the end of a six-year residency in head and neck surgery, I applied for a sub-specialty in this field. The world-renowned facial plastic surgeon and pioneer in the field, Dr. Fred J. Stucker, chose me to become a fellow. It was an intensive, yearlong study of only facial plastic and reconstructive surgery completed in 2002. During this time, I had the distinctive opportunity to participate in the initial studies to get Botox FDA approved for cosmetic use.
This 12-month study consisted of two periods. The first period was a four-month, double blind, placebo-controlled study of 537 patients with glabellar lines to evaluate efficacy of the drug. 30 days following treatment, investigators’ assessment of the improvement indicated that 80.2% of subjects treated with Botox Cosmetic showed significant reduction in severity of glabellar lines, compared to 3.0% of subjects treated with placebo showing improvement. Patients’ self-assessment yielded similar results.
The second treatment period was an 8-month, open-label period evaluating the safety of repeated treatments with the drug. 373 subjects from the first period continued into the second period. Of these subjects, 2.1% reported blepharoptosis (droopy eyelid) following the first treatment, and 1.2% reported this effect after a second treatment. 49% of subjects reported side effects of any type.
In April of 2002, Botox was approved for the treatment of moderate to severe glabellar lines (brow furrow) in adult men and women, ages 65 and younger. With a series of injections of purified protein directly into the effected area, Botox works by blocking nerve impulses to relax the contraction of the two major forehead muscles. It’s these contractions that cause the vertical wrinkles between the eyebrows. Botox was previously approved by the FDA for the treatment of several neurological disorders, including strabismus (crossed eyes), blepharospasm (uncontrollable blinking), and head position and neck pain associated with cervical dystonia (a movement disorder characterized by involuntary muscle contractions).
Among other important aspects of my training, it was impressed upon me that having integrity and high ethical standards should be a priority with every physician and surgeon. Participation in these studies confirmed for me the importance of being honest and truthful with patients. It’s not only the ethical thing to do, but it is paramount in the treatment and recovery process.
Another virtue to possess in this field of medicine is that of compassion. Being sensitive to a patient’s individual needs is crucial, especially with those patients who have experienced a medical trauma or have a birth defect. Identifying with the needs and desires of the patient is essential in the process of helping them achieve their goals.
My first visit with a patient helps me to get to know them better. I discuss with them their concerns and go over with as much detail as possible what the patient’s particular procedure will involve. I welcome questions and answer them honestly. After an examination of the patient’s facial structure, their medical history and general health status, I will determine the safest course of treatment that will achieve the best results for them.
In Part II of this article, I will go into more detail regarding the empathy component of my practice. I look forward to sharing with you the gratifying experiences I’ve had with some of my patients. These experiences were made even more rewarding for everyone involved because of the care and compassion the patient received.