Dr. Z’s Buyer Beware!

When I was a medical student, Linus Pauling visited our medical school and gave a lecture. Dr. Pauling had won a Nobel Prize for a vast body of work in chemistry including the elucidation of the chemical structure of proteins. His talk, however, had nothing to do with any of the topics for which he was famous. Instead, he spoke of the benefits of massive daily intake of Vitamin C, most notably its ability to influence aging, slowing the whole process. His conclusions were without scientific merit. The talk was really nonsense, in the end. There was simply no scientific evidence to support his claims.

Let’s explore some common issues I encounter so you can avoid them.

Appearance

This is a true story of a patient of mine. Brenda had recently divorced and had not worked outside the home for several years. She was ready for a fresh start. Her children were now grown but had left her with the ravages of pregnancy and motherhood. Her breasts sagged and her abdomen protruded. To make matters worse, aging in her face made her look older than her years, betraying the youth and vitality that she still felt.

Brenda decided to invest some money in her appearance. Psychologically she needed a lift. She felt old and a bit used up. She wanted to meet someone new but didn’t feel desirable. Although financially independent, she wanted to find work. She was losing her sense of worth.

Lasers and Gadgets

The cosmetic marketplace is littered with all sorts of gadgetry. I was once in attendance at a professional convention where manufacturers of products, potentially useful to plastic surgeons, were on display. My eye was caught by the sight of a beautiful woman in a sequined dress. She had a gorgeous figure and chose to show it off with the cut and fit of her clothes. This sales rep was standing before the newest gadgetry designed to remove fat without diet or surgery. Two rollers were aided by a suction device to pull skin and fat into position for kneading away unwanted blubber. To legitimize this quackery, a photo booth to show before and after shrinkage was part of the package. And for $35,000, they were practically giving it all away.

Operations

I was asked to review a malpractice case several years ago. A well-trained plastic surgeon had performed a “new” operation to rejuvenate his patient’s face. This procedure had been proselytized at several medical conventions and was “all the rage” for restoring youth to the face. This surgeon was familiar with the anatomy and had performed similar dissections on patients who had suffered facial trauma. With the patient’s acknowledgment that this was the first time he had performed the operation for strictly cosmetic reasons, the procedure was carried out.

Skin Treatments

Skin is the largest organ of the human body. To appreciate the concepts in this chapter, a cursory knowledge of anatomy is needed. The capabilities and shortcomings of skin treatments are related to the depth of their action in the skin. For that reason, we will be looking at applications to the skin relative to penetration of the various levels.

Simplistically, the skin is divided into 2 layers (with other sub-layers), the epidermis and dermis. The epidermis is renewable. If the epidermis is scraped off, it will be replaced by a new epidermis in healthy skin. It is constantly being turned over. The dead cells on the outer layer fall off. These are replenished by new cells at the deepest level of the epidermis. They gradually become more and more superficial until they arrive on the surface and fall off themselves.

Wounds

Several years ago I was vacationing in the Caribbean and went for a swim across a small bay to what I thought was an uninhabited beach. As I emerged from the water, however, I saw a young woman lying on a towel in somewhat of an awkward position. I noticed she had a fresh scrape on her lower leg. I assumed she had fallen and injured herself, perhaps on a rock. She was posturing herself so that the injury would be directly in the sunlight. I presumed that she believed that somehow, the ultraviolet rays from the sunlight would have a healing effect.