Ask the Plastic Surgeons

Dr. Gustav J. Lo, MD

Cosmetic Skin and Laser


How have attitudes changed toward cosmetic surgery?

Both are much more common and more accepted than in the past. In the 12 years we've been doing non-surgical aesthetics (laser treatments, Botox, fillers), the number of annual procedures in that field has more than tripled. Having an aesthetic provider is becoming almost like having a hair stylist; almost everyone does SOMETHING.

What's new, what are you excited about in your practice?

We have three new treatments at Cosmetic Skin and Laser Center. Cellulaze is the first and only device that gets rid of cellulite long term, not just a few months. For years people have asked about something that lasts more than a few months and we finally have a solution.

In addition, Smartlipo Triplex is new (laser lipo) and faster, with less downtime. We can shrink love handles, abdomens, or inner thighs in about an hour. And the advantage of Smartlipo versus regular lipo is the skin tightening, the smoother results, and no general anesthesia. It's an in-office procedure.

And then there's Coolsculpting (which University of Michigan just added to their practice). It's the "fat freezing" machine that shrinks bulges by 20 percent in a one-hour treatment with absolutely no downtime and no incisions.

What do you consider your practice's specialty?

There are two: We're the top injectors in the state (platinum-level Botox provider for nine years and top Restylane/Perlane provider in Michigan), and we are definitely becoming well known for our Smartlift treatments. Smartlifts dramatically smooth and tighten the face and neck with one tiny two-millimeter incision under the chin and five days of healing time. We find people really want to see significant but natural results and many are still afraid of facelifts. This procedure takes an easy 10 years off the face and costs about one-third the amount of a facelift.

How is the northern Michigan market in terms of pricing and technology? Are there too many specialists in your field or not enough?

In our practice, the northern Michigan market is a direct reflection of the national market. Demand for nonsurgical aesthetics is high across all socioeconomic groups, and our clients clamor for the newest, latest, greatest treatments that they read about and see celebrities getting. That's why we're constantly training on new techniques and investing in new devices. Northern Michigan clients absolutely demand state-of-the-art treatment. Pricing is actually a little less up here than the national average.

Has ageism in the workplace/job market affected your business? Are people coming in to refresh their look before going back into the job market?

Sure, we see people of all ages, first job to last job. Everyone wants to look rested and fresh, not tired and mad. You wear make-up, eat healthy, exercise, get your hair done and take care of your skin. There are so many simple and effective treatments now for wrinkles, sagging, age spots, etc.

Have you had any work done? If so, what and why? If not, what might you consider doing in the future and why?

Every employee at CSLC has had lots of procedures. Most of us have had Smartlipo, Ultherapy skin tightening, Dysport/Botox, fillers, peels, and FX. It's the best advertisement to show our clients or people that walk in that you can do all these treatments without looking "done."

Adam Smith, MD

Borealis Plastic Surgery

Why are patients choosing Traverse City?

People aren't coming here for surgical procedures because of pricing; it's actually more expensive, facility-wise, up here.

I trained at Rush University in Chicago, which is one of the best in the country. When I told my mentor there the prices we charge for facility fees, he was aghast. For example, here we charge a $2,000 facility fee for a breast augmentation. At Rush University, it was $700.

That being said, the reason people come here is because you can be operated on by somebody who was trained in Chicago by the best, but you are getting invidualized care while your family has a fun vacation. Medical tourism is becoming more and more popular; especially given the plastic surgery disasters you see when people go overseas.

Speaking of overseas surgery, you can't imagine how bad it can be. I had one patient who had a tummy tuck, lipo, the whole deal. She paid $13,000 for the surgery, $1,500 for the flight, and $1,000 for the hotel. I told her if she had come to me, it would have been $1,000 less. Her jaw dropped. Plus, people don't factor in the complications that can arise.

As for regionally, the only way I can stay competitive is to slash my rates. We still can't compete with Grand Rapids [because of the facility fees], but we can compete with Chicago and other large markets.

What's new in your field?

I think what you'll eventually see here is what's happening in other, larger markets: male plastic surgery. It's through the roof, especially minimally invasive procedures like Botox, skin rejuvenation, and lipo.

I have a fair number of patients, both women and men, who are taking a look at getting group rejuvenations. The whole office comes in; it really works. Their own clients notice and say they all look bright-eyed and bushy tailed.

What is your practice's defining service?

The other guys up here are great, they do a great job. My approach is very different, because plastic surgery training is different across the board. Yes, you want a physician that is board certified, but what are they trained to do? Some places do mostly hand or mostly burn. My program was sort of an oddity: We focused from the chest on up, and were big on craniofacial reconstruction. So that's my specialty; I did three to four cleft palates a week.

My specialties are craniofacial and breast reconstruction. I also focus on pediatric plastic surgery, face lifts, rhinoplasty, and body contouring.

As far as new equipment goes, my goal is to provide help to people using tried and true standards of care. When it comes to lasers or liposuction with ultrasound, I tell people the truth and help them understand we can do the same with less downtime. For example, we can do an $80 chemical peel with less downtime versus a laser procedure.

Discuss the northern Michigan market: pricing, competition, etc.

I would actually say there are not enough plastic surgeons in practice. But believe me [when he first came to Traverse City 18 months ago], every one of [the other plastic surgeons] said we do not need another plastic surgeon in the area.

Right now, my patients are about 30 percent cosmetic, 30 percent craniofacial and pediatric, and 30 percent reconstructive.

So now I'm booked two months out for surgery, especially for cranio-facial and pediatric work. To be honest, these specific needs will attract one or two more surgeons to the area.

Specifically, we need people to take care of the patients who are traveling to Ann Arbor. We can do better up here.

With respect to ageism in the workplace, is plastic surgery necessary?

Absolutely. In sales, your appearance sells. People are less likely to buy from a 70-year-old than a 50-year-old. So I think we'll see a lot more cosmetic procedures around here in the next 10 years.

What's next in your practice/field?

Basically, in Traverse City there is a massive amount of physicians headed toward retirement age. There doesn't seem to be many in the middle ground.

So, you have this massive turnover of physicians in the next 10 years; the younger physicians will have to step up. But the biggest thing is the new health care laws. We all know it's going to socialize medicine, so at the end of the day you have to streamline your process.

My goal would be to have one plastic surgery group under one roof as a collective whole, with patient-centered care.

So, if it's wounds, the patients would be sent to Matthew [Smith]. If it's breast, send them to Steve [Thomas] and Chris [Jeffries, MD; Thomas' partner]. If it's pediatric plastic surgery, to me. We all do a great job, we all do different things, but in the future I would like us all to work as a team.

In the immediate future, we will continue to expand Borealis.

I'm also fairly active politically in the hospital, pushing [technology] and conversion to electronic medical records. I think these steps are vital to Munson becoming a referral center, but plastic surgery is just one small cog in the wheel.

People who live here deserve a medical institution that is world class, and I know we can be competitive in a national market.

Have you had any work done? If so, what and why? If not, will you in the future?

Yes. I have Botox every three months. My physician assistant does it. I do it as a prophylactic thing; I have a fair amount of furrows in my forehead for a 32-year-old.

One time a month I get a mild chemical peel or heavy facial from the medical spa to maintain and rejuvenate the skin. Appearance sells, and you don't want your physician to have deep furrows or anything.

In the future I might need lipo on my chin, but not yet.

F. Matthew Smith, MD, FACS

Great Lakes Plastic Surgery

What's new; what are you excited about in your field?

For several years, I've been the physician champion and medical director for wound care and a comprehensive wound care program, which is now a reality. [Beginning next month, Smith's building will house the Advanced Wound Center in partnership with Munson Medical Center.]

Patients with chronic wounds, especially those with diabetic ulcers, have their amputation rate reduced by half when they have access to a dedicated wound care center. The Advanced Wound Center will have therapists, physicians and nurses with all standard of care modalities, such as technical dressings, hyperbaric treatment, and more. The location [on Anna Road] is perfect, because many of these patients are debilitated. They needed a location that was easy to find and navigate.

As for cosmetic and reconstructive surgery, what's exciting is that we are achieving much more natural results with less downtime. Technological advances and herbal medications have made cosmetic surgery more available to people than it was 30 years ago. Now, you don't need four to six weeks to recover.

What is your practice's defining service?

I think my gold standard is probably breast work, using endoscopic augmentation incisions, which are significantly smaller than open techniques.

I've been doing a lot of facelifts these days because of patient referrals. Those are the main things I'm doing in terms of reconstruction.

Minimally invasive procedures tend to be fillers and fat transfers. That's one of the new things and it's great. It's non-reactive, easy to put in with predictable results. Harvesting fat from a patient and getting it to be there permanently has been a significant development.

And of course there is Botox … when I started in 1998, there were only 3,000 Botox doses a year being administered. Now there is more than three million. It's a great, predictable drug.

Discuss the northern Michigan market: pricing, competition, etc.

There is probably one more surgeon here than the market can bear, with five of us now in active practice. Five years ago, there were only three of us, so it's made it a lot harder to keep a market share.

Right now in my practice, by the time patients get to me, they are past all preventative care. Twenty percent come through to prevent or slow down the aging process through Retin A, nutrition, and sunscreen; the other 80 percent of my cosmetic patients are there to repair damage.

In terms of our market share, I think one of the things we see all to often is that we lose significant amounts of patients to Grand Rapids. This is a direct result of none of us having an in-office operating room, which they do have in Grand Rapids. Honestly, there's just not enough volume to support that right now.

So, you are at the mercy of what facilities charge. Our facility fees are more than the state average; monopolies are a great thing, I guess. Munson has a pretty nice lock on our area.

With [Flint-based hospital] McLaren moving in [through its ownership of Northern Michigan Hospital in Petoskey and partnership with Elk Rapids Family Practice], I think it's a great thing for patients, because now they have a choice.

With respect to ageism in the workplace, is plastic surgery necessary?

First off, body image is a huge part of how people think of themselves. I have a lot of patients who are looking for a job, who feel that they are older and won't be able to keep up with a younger person because of appearance.

A lot of the work I do in that regard is facial, and I have been seeing a lot of people who are recently divorced and want to address something that has bothered them for a long time. If that one negative thing is gone, that confidence is projected. I make sure to spend at least an hour with a new patient and try to find out what bugs them and why. It's the most important thing I do.

What's next in your practice/field?

What's next for me is, with respect to the wound care work I'm doing, is setting up a network within the state of wound care centers, and developing evidence-based protocols.

If you run the numbers, just in our referral area alone, we have nine percent of the population that is diabetic, with 50 percent of the diabetic population suffering from chronic wounds. That means 3,000 to 4,000 of people are in our area that need wound care. If we can heal half of them, we will impact a huge number of people.

Have you had any work done? If so, what and why? If not, will you in the future?

Have I personally? No. If I would do anything, I would use the fillers or Botox. To be honest, I need the ability to frown at my kids still – I need that nonverbal communication.

Peter J. Sneed, MD, ASOPRS

Grand Traverse Ophthalmology Clinic

Why are patients choosing Traverse City versus metropolitan areas?

Since I am the only eye plastic surgeon in northern Michigan, with no one north of me, I see patients from a pretty wide range: Petoskey, Harbor Springs, Rogers City, and Cheboygan, not to mention the UP and elsewhere.

What's new in your field?

I think much of what I do has been around for a long time. However, just recently I did surgery on a young girl who was in a bad car accident. She lost one eye and after reconstruction that eye had a sunken look to it. To make it look more natural, we harvested fat from her abdomen and injected it into her socket. Following her recovery, she looked amazing; it was just remarkable.

In terms of newer techniques, I am using quite a bit of filler for the eye and face. It's an area that has seen quite a bit of advancement. The body accepts the material quite easily. And then there's Botox, which is a great treatment for the right people.

I'm not one to be the first to try something, though. They can try it in Hollywood first, and after a few years, I might give it a look if it's been proven to be safe.

What is your practice's defining service?

My practice's trademark is eyelid surgery. To help with the lower eyelid and bags under the eyes, I will use a laser for smoothing and tightening to get rid of fine lines and wrinkles. Those two things are pretty unique.

Discuss the northern Michigan market: pricing, competition, etc.

I think in this country we base our decisions on price much too often and that seems to trump quality. I think you can have both.

There is so much competition out there: Florida, Arizona, Detroit, and Grand Rapids. In my mind, price takes care of itself. I shouldn't charge two or three times more, but there is a cost to employing good people at a nice center like the one we have here.

So just because it's cheaper to go the GR, then I say if that's your criterion, then please go to Grand Rapids. It's okay to not be the cheapest person around. This approach has certainly validated itself at our surgery center, which I believe, volume-wise, is the second busiest in the country.

People are willing to pay for quality, especially if the stuff you are paying for is important, like a surgical procedure.

With respect to ageism in the workplace, is plastic surgery necessary?

This is a great question, because people ask me all of the time if it's wrong to be vain and have cosmetic surgery.

We have a lot of very healthy, outgoing people in this area, so if that's what they want to do, I'm all for it. I'm not here to judge. You've got to feel comfortable with yourself.

However, periodically the idea of surgery comes up because someone is having relationship troubles. In that case, I'll talk them out of it until another time of life comes.

People view plastic surgery in general as a vain, shallow Hollywood thing. That's not at all what it is.

What's next in your practice/field?

There are always things that are being developed in research; that's the beauty of American medicine. Brilliant minds are always thinking and wondering if this is the right way to do things. Or is there a better way?

So, I try to emulate that in my own practice. It's the reason doctors go into medicine; we're inquisitive and want to do better.

Have you had any work done? If so, what and why? If not, what might you consider doing in the future and why?

I have not had any work done, except trying to get into better shape to decrease my Vasa [cross country ski race] time and lower my golf handicap.

I don't anticipate doing anything because my personality is such that I feel 25 most days. If something happened to change that, maybe I would. For now I'll continue to eat right, exercise, and take care of myself.

Steven V. Thomas, MD, FACS

The Center for Plastic Surgery at Copper Ridge

Why are patients choosing Traverse City versus metropolitan areas?

We see a lot of out of town patients who get their surgical procedures done; they come here because they are somehow associated with the area or have heard about a specific doctor.

I have noticed more and more people coming to Traverse City from places like Chicago and Detroit. They come because they see the good work being done here; they've seen their friends' work and know they'll be in good hands.

More than 50 percent of my business is from out of town, but from out of the northern Michigan region, I would say that number is less than five percent.

What's new in your field?

The newest thing is combining surgery with nonsurgical laser procedures. This way, you offer a wider array of procedures that are customized to each patient. We can more easily lift, tuck, sand and smooth the skin in a way that less invasive with fewer days of downtime for the patient.

Secondly, we have seen growth in the use of fillers and lasers, techniques we use for wrinkles. In the past, we always did surgery. Now we are marrying the two components together.

What is your practice's defining service?

Cosmetic surgery is popular here but what we do the best is breast reconstruction. We do it well; it's the one thing we excel at.

What sets us apart is the technology and our technique in which we reconstruct a breast with the patient's own tissue. We are one of the few centers in the state that does that.

Cosmetically, we have two Sciton lasers, which are very advanced. They are about 18 months old and are considered the Cadillac of lasers. They are very malleable; very easy to work with. If the patient only wants three or four days of recovery, the lasers can be tuned for that. Or we can be more aggressive. The lasers work, and they work well.

Discuss the northern Michigan market: pricing, competition, etc.

I feel we have exactly the right number of physicians specializing in plastic surgery. In all of northern Michigan, Traverse City is truly the hub with its full service specialties.

We have the center here, Munson Medical Center, and our excellent reputation. We have a safe, high-tech advanced facility with plenty of backup. And really, there's nothing south of here until you get to the Ludington/Grand Rapids area.

In terms of pricing, we are 25 percent less across the board if you compare Michigan only; however, surgically you can't compete with Grand Rapids because those physicians own their own surgical center, which means they can charge their patients a much lower facility fee than we can.

That being said, we're not out to kill anybody with outrageous charges; we'll hold where we are for the time being because we are busy.

With respect to ageism in the workplace, is plastic surgery necessary?

If you mean this morally and ethically, then of course my answer would be no. However, a person wants to look and feel better, and this feeling matters.

But honestly, it shouldn't be what my perception of your appearances is; that's crap. People who are older bring experience to the table. Do people who are going into the workforce at an older age feel it matters? Yes. In fact, I would say about 40 percent of my patients come to me for preventative work like Botox and fillers; the rest come to me for corrective work.

It takes a lot more to fix problems than to maintain what you have.

What's next in your practice/field?

The purchase of the Sciton lasers was huge for us. On the horizon, we see more refined fillers coming our way. We also see using a derivative of the patient's own stem cells to repair skin. This is where we would harvest fat, spin it, and then reintroduce it in a cost-effective way.

Have you had any work done? If so, what and why? If not, will you in the future?

Not yet, but it's coming soon. I will definitely have the laser work done. I just got back from the Caribbean and I'm a little darker than usual. As soon as I fade, I will have the Sciton procedure.

Eventually, I will probably get my smile wrinkles taken care of and both of my eyebrows taken up. They're encroaching on my vision!