Colorado’s own Heidi Montag Pratt of The Hills MTV reality series now in its sixth season underwent comprehensive plastic surgery earlier this year generating endless news feeds and paparazzi coverage. “This situation should not be perceived as reality,” says Jeffrey Raval, MD, FACS. “Reputable plastic surgeons do not engage in performing surgery to gain notoriety.”

While undergoing 10 plastic surgery procedures performed in one day – a mini brow lift, Botox injections, a nose job, fat injections in her cheeks and lips, a chin reduction, liposuction to her neck, her ears pinned back, buttocks augmentation, liposuction to her waist and thighs, and revision breast augmentation—Montag had the surgeries taped purportedly to use in a future reality show.

Post-surgical photos of Montag reveal a Barbie-shaped physique. “Truly, the responsibility of any cosmetic surgeon is to vet elective surgery options with a patient prior to surgery. Consults with the doctor would routinely identify what surgical procedures are indeed going to enhance an individual’s lifestyle and improve their health. A perceptive plastic surgeon will be able to assess whether an individual is seeking surgery for all the wrong reasons, i.e. to please a partner or to gain notoriety. From the outside, it would appear that this particular celeb pursued surgery to generate media attention rather than to correct physical flaws.”

Dr. Raval has gained a reputation among fellow surgeons in the Rocky Mountain West of being The Nose Doc, particularly proficient at revision rhinoplasty surgery, repeat nose jobs that are more complicated than first-time nose surgeries because of the scar tissue that develops in any surgical area.

Dr. Raval pioneered the use of Dermamatrix in nose surgeries resulting in a smoother, more natural shape to the nose. Introduced in 2006, this dermal matrix is preferred over others because of its uniformly soft and pliable consistency and its increased tensile strength.

To see a video on the benefits of Dermamatrix, go to www.ravalmd.com/rhinoplasty.html.

Denver, Colo.— As an injector trainer, one of a handful of surgeon trainers in the state, Dr. Jeffrey Raval has pioneered a new process to make the injections in this liquid facelift painless. He combines fast-acting lidocane, a numbing agent, with the injectable fillers, a practice that the FDA approved in 2009.

Injectable fillers are used on the face to turn back the clock, plumping up the face to look fresh and young, juicy even.

“I liken the face as we age to a grape that slowly over time turns into a raisin,” says Dr. Raval, who is a double board-certified facial plastic surgeon and otolaryngologist. He performs surgery on the head and neck only.

One of the greatest contradictions in aging is the loss of fat in the face while simultaneously gaining in the hips and mid-section. Well, there is a solution and it can take years off of one’s appearance, according to Jeffrey R. Raval, MD FACS. The answer is in combining diet and exercise for weight control to retain a firm mid-section with infusions of fat and filler in the face to keep it looking plump and, yes, juicy.

Of the two missions, the one that’s more painful and time consuming is definitely the diet and exercise piece. Dr. Raval explains that around the age of 35 (some studies suggest 30), the average woman loses 1/2 to 1/3 of a pound of muscle each year while gaining an equal amount in body fat. Each pound of body fat burns an estimated 5 calories per day while each pound of lean muscle mass burns approximately 50 calories per day. The result of carrying around fat vs. muscle mass is a drastically slower metabolism. A slower metabolism means weight gain, even when you don’t change eating habits.

“Keeping your physique young looking means an investment of time into regular workouts and it means relentless attention to caloric intake and healthy food choices,” says Dr. Raval, who fits a serious workout session into his busy life a minimum of three times weekly. “Keeping fit and trim as you age means giving up the burgers and fries you might have enjoyed as a teenager. Carbs show up on your waist and hips. Even diet sodas with artificial sweeteners can trigger the cephalic phase response—the sweet taste on the tongue stimulates the brain to eat and overeat.”

On the other hand, successful weight loss will most often result in the face looking thinner, even gaunt.

That’s because our bodies manufacture less natural collagen as we age. The skin loses its elasticity, jowls begin to droop and creases and wrinkles deepen.

At his clinic in Cherry Creek North, the upscale shopping and entertainment district in Denver, Dr. Raval performs several kinds of mini facelifts using a customized combination of facial fillers including Restylane®, Juvederm®, Hylaform, Perlane, Radiesse and collagen in combination with Botox®, Dysport® and PureTox®, three injectable products that smooth away wrinkles and creases by effectively numbing the underlying facial muscles that contract to make natural wrinkles and folds.

Using fillers, Dr. Raval is also able to correct aging jowls, filling in the areas that have receded to create a smooth jaw line, reinserting the definition that is seen on a much younger face. Additionally he can correct aging eyes by inserting filler underneath the lower eyelid where the eye begins to wrinkle and the tissue sometimes appears sunken. Filler plumps up the area, erasing lines and wrinkles and returns the eye to a much younger appearance.

The beauty in the injectable facelift, adds Dr. Raval, is that it can be performed in less than 30 minutes without general anesthesia in his office. The patient may experience a small amount of bruising, but there is no weeks-long recovery as in a traditional facelift.

For information on the One-Hour Facelift, call Dr. Raval’s office at 303-381-3223 (FACE) or read more about age defying treatments at www.ravalmd.com.

Botox injections were up 8.1%, as were Restylane filler injections. Laser treatments were up 1.6% in Q4 2009.

Is this a sign the economy is turned around? Or is it a signal that some people won’t forego ongoing cosmetic care that keeps them looking younger and consequently makes them feel younger?

“We see this as a positive,” says Jeffrey Raval, MD, FACS, facial plastic surgeon practicing in Cherry Creek North, the upscale boutique and restaurant epicenter of Denver, CO. “It underscores the value in less invasive procedures like injections done more frequently so as to forestall major cosmetic surgery.”

Dr. Raval operates his practice Raval Facial Aesthetics together with Rocky Mountain Laser Aesthetics, a laser hair and tattoo removal clinic, in the same location. He has gained the reputation of being The Nose Doc in the Rocky Mountain West by his peer surgeons who have recognized his capabilities especially in revision rhinoplasty, made more complex because of the scar tissue that results from an original nose job. Dr. Raval also has been referred to as The Face Doc for his achievements in treating head and neck needs of patients, particularly in the cosmetic market sector.

“BOTOX is the most commonly used injectable in the cosmetic field,” says Dr. Raval (www.ravalmd.com). “The filler injectables are increasingly preferred because they don’t require the downtime that a traditional face lift or forehead lift or neck lift can require. Patients are short on time, working longer hours, putting in more exhausting weeks. While they’re showing evidence of being more tired, they don’t want to appear tired because it takes away their competitive edge. Filler injectables are the ideal solution to treat this very active and busy patient.”

On Jan. 20, 1010, the International Association for Physicians in Aesthetic Medicine (IAPAM) released a report that Botox and filler injections will lead the cosmetic treatments performed in 2010 as the country works its way out of the most severe recession in decades.

The editors of Consumer Guide to Plastic Surgery concur, releasing a forecast for this year showing Botox at the top of services that patients will find the money to pay for.

The so-called “Botax” would add a 5% levy on face-lifts, tummy tucks, Botox injections and more

November 24, 2009

Cosmetic surgery and procedure patients and health-care providers are lining up in opposition to a provision in the U.S. Senate’s version of Health Care Reform which would impose a 5% tax on purely cosmetic elective procedures, a measure designed to raise nearly $6 billion of the projected $849 billion cost of the healthcare bill.

Having been tagged the “Botax” by observers — a take-off on popular Botox injections for wrinkle relief and a procedure presumably subject to the proposed new tax — the new cosmetic procedure tax is being championed as simply a tax on the wealthy who can afford it. But according to organizations representing the plastic and cosmetic surgery industry, such a tax would in fact target the middle class and working women in particular.

Jeffrey Raval, Md, FACS, a Denver facial plastic surgeon who operates Raval Facial Aesthetics, P.C., and Rocky Mountain Laser Aesthetics, P.C., calls the tax unfair and a burden on the middle class, especially women. Dr. Raval said he treats women and men from all economic levels at his Cherry Creek North offices.

The United States Senate cleared an important hurdle in Health Reform legislation Saturday night with a 60-40 vote, reflecting strictly partisan support, which will bring the Democratic leadership’s massive 2,074-page bill to the full Senate for debate as early as next week. Passage of the bill remains uncertain, as members of the more moderate wing of the Democratic Party are not in lock-step with the full caucus on many of the legislation’s provisions, and joining with the body’s 40 Republication members in opposition may leave the bill subject to a filibuster and bar a final up-or-down vote.

A report from the American Society of Plastic Surgeons (ASPS) cited many problems with the Botax provision, chief among them a 2005 survey conducted by the group indicating that only 10% of people considering cosmetic surgery over the next two years had a household income greater than $90,000 per year, a clear indication that such procedures go well beyond the privileged few. Moreover, the association said that 86% of cosmetic surgery patients are women, with the bulk of them working women between the ages of 19 and 64.

When the idea of a “luxury” tax on cosmetic procedures was first raised last summer, the White House was reportedly backing a provision that would have made the cosmetic procedure tax even higher: 10%. But when Senate Majority Leader Harry Reid, D-Nev., last week introduced the bill that will debated in the Senate, the tax rate was dropped to 5%. If the bill passes, the cosmetic plastic surgery tax could begin to be collected as early as January 2010.

Another potential problem in the bill, observers say, is the definition of “cosmetic” as it relates to the tax. Sen. Reid said he took the language for the provision from IRS rules currently in place to bar tax deductions for purely elective and cosmetic procedures. These would include, he said, anything “not necessary to ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease.” But some medical professionals worry about the interpretation. For instance, would breast reconstruction surgery following a mastectomy qualify, in that the disease itself did not misshape the breast, but rather the treatment of the disease caused the disfigurement.

To date, the only tax on cosmetic medical procedures imposed in the US has been in the state of New Jersey, a 6% tax, and early indications are that the state has realized a 59% shortfall based on projected revenue estimates when the legislature passed the measure in 2004. At least six other states – Texas, Illinois, Washington, Arkansas, Tennessee and New York – have such Botax bills introduced or budget provisions proposed, although none of them have actually passed such legislation.

“Medical professionals in the cosmetic surgery industry object to this tax provision because it doesn’t really reach the wealthy as intended, but rather it falls largely on women making less than 90,000 a year which is just the type of person we a supposed to be helping with healthcare reform and other economic stimuli the democrats are proposing,” said Dr. Raval. “Today many working people are turning to cosmetic procedures to heighten their employment prospects in today’s competitive working environment. Contrary to what the Senate Democrats are saying, this unfair cosmetic tax is indeed a tax on the middle class.”

According to statistics from the ASPS, in 2008 there were 12 million cosmetic plastic surgery procedures that would be subject to the tax performed in the United States, a 3% increase from 2007. Of those 1.7 million were surgical procedures, with breast augmentations (307,000 procedures; down 12% from 2007), nose reshaping (279,000 procedures, down 2%), liposuction (245,000 procedures, down 19%), eyelid surgery (221,000 procedures, down 8%), and tummy tucks (122,000 procedures, down 18%), the leading categories.

The ASPS said that there were 10.4 million minimally-invasive cosmetic procedures last year, an increase of 5% over 2007. Leading the way were: Botox (5 million procedures, up 8%); hyaluronic acid fillers (1.1 million procedures, up 6%); chemical peels (1 million procedures, up 2%); laser hair removal (892,000 procedures, down 2%); and microdermabrasion (842,000 procedures, down 6%).

There were also 4.9 million reconstructive procedures, presumably non-taxable, including such things as tumor removal, laceration repair, scar revision, hand surgery and breast reduction, the ASPS said. This category rose 3% from 2007 tallies.

Once again, news headlines claim that Botox® injections can be lethal. The news reports are not only exaggerated, but inaccurate in that the news stories logged don’t differentiate between injections of BOTOX for medicinal purposes and the injections for cosmetic purposes-a big difference.

“Bottom line, all the reported cases of adverse events using Botox come from injections of BOTOX for medical purposes, not cosmetic,” says Jeff Raval, MD, FACS, American Board certified facial plastic surgeon who is ear/nose/throat board certified too. “The high level of doses of Botox used for medicinal purposes can be too much. For example, there have been cases that doctors injecting Botox in the neck muscle to treat torticollis, abnormal spasms of the neck muscle, have injected too much of the toxin. The patient’s throat can close up and he/she can have trouble breathing.”

But there are no reported incidences of lethal or near-lethal use of Botox for cosmetic treatments, Dr. Raval confirms.

The dangers in Botox use surface in the press every year or so. “There is no truth to the rumor that Botox Cosmetic is dangerous,” adds Dr. Raval.