This is it! The first episode of the show that started it all… the mistruths about plastic surgery, that is. Honestly, I’m an optimist at heart, so I hate to nit/pick nip/tuck after only one episode, especially given that this is my first post, but you know what they say about first impressions and all.

So, what was my first impression of F/X’s nip/tuck? Well, if I hadn’t spent the last – and best – 20 years of my life working in the medical/aesthetics industry, I might have taken away the following from this pilot episode, which, by the way, I am going to call:

The Top 10 Things They Don’t Teach You in Plastic Surgery School:

(Note: The following quotes – believable as they may seem – are actually taken directly from dialogue in the Pilot episode.)

• 1. Use, “I’m a plastic surgeon,” as a pick-up line.
• 2. Remind people, “When you stop striving for perfection, you might as well be dead.”
• 3. When injecting BOTOX® Cosmetic, comment to your patient that, “Tomorrow, you’ll be one hot bitch.”
• 4. Remember, you’re in the “vanity business.”
• 5. Remember, what you do is important because you, “let people externalize the hate they have for themselves.”
• 6. Remember that as a plastic surgeon, you’re in the, “placebo surgery market.”
• 7. Always have a goal. For instance, Dr. Christian Troy wants a, “kick ass practice.”
• 8. Be cool. Write doctor’s excuses for kids so that they can skip school.
• 9. Drug money = new steam room.
• 10. When a patient tells you that they want to be “perfect,” nod and inform the patient that with your help, they can, “absolutely be a ’10.'”

Like most shows, this episode had multiple storylines: the first involved accepting a bribe from a mobster to perform plastic surgery that included over-the-top facial sculpting and out-of-control liposuction (both totally unrealistic); sleeping with a hot model and then selling her on everything from rhinoplasty and a tummy tuck to BOTOX® Cosmetic and breast enhancement (sure beats the Chamber of Commerce!); and, finally, dumping a dead patient’s body in the everglades. Just another day at the office… the writers’ office over at F/X!

Speaking of offices, in case you missed it, there was a quick shot of Dr. Troy’s office door, which happened to display, “M.D. F.A.C.S.” A little research will tell you that this indicates, “Medical Doctor, Fellow of the American College of Surgeons.” A little more research will tell you that the ACS admits only those surgeons who, among other things, agree to practice ethical standards. Wait a minute, didn’t the mafia boss – nicely portrayed by the always excellent Robert LaSardo – say that Dr. Troy was, “named by colleagues as someone lacking ethics?”

The fact is, plastic surgery has very little to do with “perfection,” “vanity,” or “hate.” And, it’s got absolutely nothing to do with bribes, sex, drugs and felonies. It’s about your vision of you – no one else’s. Don’t believe me? Check out these cosmetic surgery videos and see for yourself

So, if you watched nip/tuck hoping to learn everything you’ve ever wanted to know about plastic surgery, unfortunately you really didn’t learn anything in this first episode. Don’t get me wrong, it was entertaining; it just wasn’t informative. Oh, well, let’s hope episode 2 better fulfills the promise of reality-based television.

Charlie Sheridan

Medical Editor and Consultant

Just six weeks after dumping the body of a former patient in the Florida everglades, McNamara/Troy plastic surgery is back in business in an episode I’m going to call…

Dr. Troy Gets Randi… and Mandi

The show opens with the good Dr. McNamara in surgery, operating on a woman whose breast implants ruptured after her abusive boyfriend caused significant trauma to her chest.

Breasts are a woman’s most feminine feature. So, it’s no wonder that while liposuction is the most requested plastic surgery procedure between both sexes, breast enlargement – also known as mammaplasty – is the most popular plastic surgery procedure among women. Electing for plastic surgery, of course, is more than simply about how a woman looks; it’s also about how she feels. The fact is, breast enhancements to increase or decrease size or to provide a better proportion, can have a dramatic, positive effect on a woman’s self-esteem. But, don’t take my word for it; the patients in these breast augmentation videos can speak for themselves.

Unfortunately, breast implants do not last forever, and a small number of women might experience problems, such as capsular contracture (build-up of scar tissue around the implant), rupture/deflation, leakage and, as with any surgery, infection. These problems can be the result of a defective implant, surgical complications, age and, like the aforementioned patient, injury. Thankfully, the instances are rare. In fact, in 2000, a study by the Food & Drug Administration (FDA) showed rupture/deflation rates at a mere three-to-five percent at 3 years and only at around seven-to-ten percent at 5. Of course, you can reduce your chances of experiencing a problem with your implants by seeking the expertise of an experienced, well-respected, board-certified plastic surgeon that’s up-to-date on the latest advances in breast augmentation. Oh, and of course avoiding abusive men can only help!

But, I digress. So, where was I? Oh, yeah, nip/tuck…

Well, after the surgery to correct the breast implant, Dr. McNamara joins Dr. Troy who is in the middle of eyeing… I mean, evaluating 18-year old identical twins, Mandi and Randi. They’re tired of looking exactly alike… of being mistaken for the other. The two doctors recommend that the two young women try other, less permanent changes such as to the color or style of their hair. They already had their names tattooed on their backsides, and it didn’t help!!!

Mandi and Randi are afraid that when they get to college, they won’t be viewed as individuals. They’ve made up their minds – they want plastic surgery. And, they’ve even brought in a picture of Jennifer Garner from a magazine to show the doctors how they want to look. Believe it or not, this happens quite frequently… and can prove quite helpful! While genetics and physical attributes such as bone structure contribute to how dramatic of a change is possible, it’s often a helpful communication tool. Anyway, the girls want what they want, and Dr. Troy is more than willing to give it to them.

By the end of this episode, Dr. Troy attempts to have sex in a tanning bed; takes the son of his best friend/partner to a strip club; attempts to have sex with a stripper before calling her a, “carnival freak” and handing her his business card; sets up a rendezvous with his best friend/partner’s wife; and, apparently has sex with the twins, Mandi and Randi, who if you combine both their ages are younger than the juvenile Dr. Troy. How does he have time for surgery?! Anyway, at least he apologizes for his mistakes! Gotta hate yourself for lovin’ him.

And, if you’re considering breast augmentation, you gotta know why you’re doing it, do your research and find a qualified plastic surgeon. See you next time!

Charlie Sheridan

Medical Editor and Consultant

Another week, another supposedly “inside look” at the world of plastic surgery in South Florida… as seen through the eyes of a room full of Southern California writers in an episode I was going to call, “Lies, Lies and More Lies”, but finally settled on…

The Ten Million Dollar Man!

Like I said in a past post, I’m an optimist.

The show opens with Dr. Christian Troy in consult with Mr. Diamond, a Michael Jackson impersonator. Mr. Diamond is in town and in the market for yet another nose job (rhinoplasty). In the nicest way possible, Dr. Troy tells the would-be King of Pop to “beat it”, rightfully recommending against any further work. The episode then proceeds to focus on an important issue relating to plastic surgery – what to do with a potential patient that is obviously mentally unstable?

Nanette Babcock is just weeks away from her 10-year class reunion. She’s also overweight. Although she’s recently begun working out and watching what she eats – which is good – she’s not seeing the immediate results that she desperately desires. Of course, it doesn’t help that her results are unrealistic as evidenced by the wall in her apartment covered with images of freakishly thin models torn out from various fashion magazines. Desiring to make a good impression on the immature classmates that used to tease her, Nanette wants the works – liposuction, a body lift, breast augmentation… You name it, she wants it… and, she wants it now!

Unfortunately, Nanette is not only dealing with a lifetime of bad habits and, probably like each of us, genetics, but also suffers from a bipolar disorder. Worse yet, she’s failed to maintain a drug regimen to control her mood swings. Now, medication alone does not preclude someone from benefiting from plastic surgery. In fact, Plastic and Reconstructive Surgery (Vol. 114, p. 1927) reports that in a study conducted by David Sarwer (University of Pennsylvania School of Medicine), 18% of patients who elected for cosmetic surgery were on a drug regimen – usually an antidepressant – to treat a psychiatric condition. It’s been suggested that taking a medication to control one’s mood may simply be a sign that a potential patient pays as much attention to their mental health as they do their physical. Requesting surgery so soon after stopping medications cold turkey – and against the advice of their medical professional – should preclude someone from plastic surgery. Dr. Troy again refuses to take Nanette on as a patient, and rightfully so, for she was so unstable that the episode regrettably ends with her taking her own life.

While we’re on the subject of studies, Dr. Troy commented that, “women who have breast implants are three times more likely to kill themselves.” The fact is the National Cancer Institute reported in Epidemiology that in a study of 13,500 women who had breast implant surgery for cosmetic reasons, nearly every possible cause of death – cancer to disease (circulatory, digestive, endocrine, nutritional and immune) – was in reality lower among those patients that had implants when compared to both the general population and the 4,000 patients who had elected for some other form of plastic surgery. So, the study suggests that women who have implants actually have a lower mortality rate. Why? The theory is that people who undergo elective surgery are probably more concerned with their health – and, thus, healthier – than those in the general population.

But, as usual I digress. It’s just that I not only work in the aesthetic medical industry, but have myself elected for plastic surgery, so you’ll have to forgive me if I get a little worked up with writers – or anyone for that matter – who perpetuate myths about plastic surgery. I know, writers aren’t surgeons; how are they supposed to know the facts? Research! Or, they can chat with me. You can too! You can also watch these breast implant videos, because like they say, a moving picture is worth a thousand words. Anyway, where was I? Oh, yeah, nip/tuck…

Was there anything that we learned in this episode? Oh! Dr. Troy wears Versace underwear! By the way, this is the first episode that didn’t feature Dr. Troy having sex with a patient! I know, there have only been three episodes, but it shouldn’t happen even once! He did sleep with a patient who was threatening to file a $10 million malpractice suit – and thus “The Ten Million Dollar Man” episode title – but he didn’t have sex with her. They just cuddled. Am I seeing some growth in the character? I don’t know, but I’ll see you next time!

Charlie Sheridan

Medical Editor and Consultant

Each week, nip/tuck starts with what’s known in Hollywood as a “cold open.” Also referred to as a “teaser,” a cold open is when a show’s plot begins prior to the show’s title sequence or running of the opening credits. This week, the cold opening involved Dr. Troy attempting to barter his services (in this case, plastic surgery on a salesman’s girlfriend) for a discount on a Lamborghini. Hey, it could’ve been worse; he might have offered another one of his many “services.” I guess you don’t know if you don’t ask.

Anyway, with my cold open out of the way, let’s get this show on the road with an episode I’m going to call…

Roll title…

You Be the Judge.

The American Society for Aesthetic Plastic Surgery (ASAPS) reports that in 2006, over 11 million surgical and non-surgical cosmetic procedures were performed in this country. If you’d like to see some patient stories regarding some of the more popular procedures, take a look at these videos of rhinoplasty and tummy tuck videos. Where was I? Oh, yeah… now, I’m fully aware that while chondrolaryngoplasty might not be as familiar to most as say rhinoplasty (nasal surgery), abdominoplasty (tummy tuck) or augmentation mammoplasty breast enlargement, but for some transgender individuals, the “tracheal shave” is an important step in becoming who they feel they were meant to be.

Sofia Lopez, a male-to-female transgender shows up at McNamara/Troy after unfortunately receiving a less than professional tracheal shave – or chondrolaryngoplasty – from an unscrupulous, probably alcoholic plastic surgeon operating illegally outside of the system. Not good, especially considering that a tracheal shave – as the name more than implies – involves the shaving away of the larynx’s largest cartilage (the thyroid cartilage) so as to reduce the size of the “Adam’s Apple.” The hope is to provide a more feminine appearance. Obviously, it’s a delicate procedure that when performed by an inexperienced – or drunk – surgeon can result in everything from difficulty breathing, and problems swallowing, to damage to the patient’s voice and scarring. Sofia’s problem of both significant physical and emotional scarring – was remedied by Dr. McNamara, which brings me to the really great thing about being in this industry…

The fact that plastic surgeons are capable of more than enhancing the body; they are able to enhance the spirit. A caring, qualified plastic surgeon can increase a person’s self-esteem; they can help a patient not only rebuild a life, but as was the case with Ms. Lopez, start a new, more fulfilling one; and, they never judge a person by who they were, are or who they want to be. Why? Because a plastic surgeons understands that it’s not his or her job to determine what’s “normal.” So, whether a patient’s looking for implants or injectable fillers to enhance the lips, breast reduction or an effective wrinkle treatment, a plastic surgeon is there to help, offer hope, and never ever judge. Sort of like your best friend… your really smart, highly skilled, board certified best friend.

So what else happened on nip/tuck? Oh, you know, the usual: Dr. Troy attended a porno party where he was immediately propositioned… by an old classmate and rival looking to hire him away. And, as usual, Dr. Troy uttered some outrageous line about plastic surgery: “The line that divides the porn industry and plastic surgery is a thin one – we’re both selling fantasy.”

Too bad no one’s buying it, Dr. Troy.

See you next time.

Charlie Sheridan

Medical Editor and Consultant

Episode 5! Where did all of the time go… and how do I get it back? Actually, it hasn’t been all that bad. I’ve been entertained… especially at how many different ways the writers can misrepresent plastic surgery and plastic surgeons.

It’s sort of a joke, really… and it might be quite amusing if it weren’t for the fact that nip/tuck is supposed to be a “reality-based” drama, and that many people considering plastic surgery – surgery that could very well better their lives – might be negatively swayed by the show. That’s unfortunate. That’s entertainment… I guess. And, that’s precisely why I’m suggesting you check out these real cosmetic surgery videos!

With that said, I’m starting to see some growth in the characters, especially Dr. Troy. I mean, doesn’t it seem like only yesterday that he was seducing patients into plastic surgery and passing out his business card at porno parties? Now, he’s attending sexaholics anonymous. Our little boy’s growing up, although he’s still got a long way to go considering he walked out halfway through (he didn’t even take the time to sit down) and proceeded to sleep with his sponsor… and the girl at the office who waters the plants… and a co-worker. Talk about falling off the wagon! In between, he somehow found time to perform asian eye surgery (blepharoplasty), laser tattoo removal and nasal surgery (rhinoplasty).

Anyway, as my mind drifted, I got to thinking about all of the good that plastic surgeons do; there’s a lot, but I’ll keep it to a minimum. The tendency, of course, is to think of those electing plastic surgery as vain – women either seeking to enhance their breasts or patients hoping to achieve a more youthful look (and, by the way, in most cases, receiving just that). The fact is plastic surgery does so much more:

• plastic surgery can work miracles on people born with deformities
• plastic surgery can help people disfigured by domestic abuse, war or accidents
• plastic surgery can help those who are older (and wiser) erase the faded reminders of their past

So, forget nip/tuck, and please just remember what plastic surgery really is all about – helping people to look their best so that they can live life to the fullest.

Oh, before I go – for your record keeping purposes – I’m calling this episode…

Just the Facts.

See you next time.

Charlie Sheridan

Medical Editor and Consultant

This week, nip/tuck got it right! My work is done…

Seriously, they got it right. No, I’m not talking about plastic surgeons like Dr. Troy having sex with their co-workers at the office; no, I’m not talking about plastic surgeons like Dr. Troy advising teenagers on the rules of three-way sex; and, no, I’m not talking about plastic surgeons like Dr. Troy finally coming to the realization that they have to get their life back on track and stop sleeping with their patients. No, I’m talking about patient, Megan O’Hara. She said, “You don’t cure an internal problem with an external fix.” She’s right, in this, an episode I’m going to call…

For All the Right Reasons.

Megan O’Hara was diagnosed with breast cancer. She beat it. To thank her husband for sticking with her through the radiation and chemotherapy treatments (and the infertility resulting from the chemo), as well as the double mastectomy, she decided to seek a consultation at McNamara/Troy regarding breast reconstruction and C-sized breast implants. “Thank you, honey, for giving me the strength to beat cancer.” Husband: “No, thank you!” Seriously… this is a serious subject.

According to the American Cancer Society (ACS), over 178,000 will be diagnosed with breast cancer in 2007, making it the most prevalent cancer in women. Of these women, it is estimated that almost 41,000 will not survive. So, with the exception of her husband, Mrs. O’Hara is one of the lucky ones. Of course, she’s just a character. In real life, real women have to contend with real breast cancer and what to do if they’re one of the lucky ones. According to statistics from the American Society of Plastic Surgeons (ASPS), 5.3 million reconstructions were performed by plastic surgeons in 2006. Of these, over 56,000 were breast reconstruction procedures.

Breast reconstruction can be performed to recreate natural looking breasts in patients that have had a mastectomy. Obviously, the surgery’s complex. For the surgeon, it’s technically complex and for the patient, it’s psychologically so. For instance, many women find it difficult to contend with a cancer diagnosis and subsequent treatment, while at the same time, attempting to decide whether or not to elect breast reconstruction surgery (note: although it can be performed later, having the surgery together with a mastectomy historically produces optimal results). Should a woman elect breast reconstruction, her plastic surgeon has four treatment options, depending upon factors such as the patient’s age, overall health, anatomy and, of course, her goals:

• breast implants
• TRAM flap: breast is reconstructed using fat, skin and muscle harvested from the patient’s abdomen
• DIEP flap: like TRAM, but only utilizes skin and fat
• LD flap: breast is reconstructed using skin and muscle harvested from the patient’s back

Regardless of the treatment option, breast reconstruction is absolutely not associated with a recurrence of breast cancer. And, should the disease recur, the reconstructed breast does not interfere in anyway with either radiation or chemo treatments. So, what did McNamara/Troy’s patient decide?

In the end, Mrs. O’Hara made an important decision (and a wise one at that) – she left her husband and opted against the C-sized breast implants. The fact is that although breast reconstruction can give a patient back what most consider a woman’s most feminine features, breasts don’t make a woman a woman (and neither does a husband, especially one who needs to be rewarded for sticking with his wife during an extremely difficult time). Which somehow brings us full circle, back to Dr. Troy.

Dr. Troy suggested in this episode that the practice advertise, using the slogan, “You know you can look better.” Obviously, each and every one of us can look better, and plastic surgery can and indeed helps millions of men and women every year to do just that. In fact, you can hear from some real patients about how plastic surgery helped them in these plastic surgery videos. But, when it comes to when or why you elect plastic surgery, only one reason really matters – yours.

See you next time.

Charlie Sheridan

Medical Editor and Consultant

Last week, nip/tuck dealt with breast reconstruction; this week, it’s breast reduction. The American Society of Plastic Surgeons states that in 2006, almost 20,000 breast reduction procedures were performed in the United States. That’s 22% increase since the year 2000. Why would a woman elect breast reduction, you ask? And of the 13,585,134 cosmetic and reconstructive procedures less than 20,000 were breast reduction? There are many reasons a woman might enjoy a more fulfilling life with smaller, firmer breasts – to ease back and neck pain; to eliminate the rash that can form under large, pendulous breasts; and, to put an end to the staring of strangers. But, I wasn’t talking about women; 20,000 men last year elected breast reduction. Like I said, it was the focus of this week’s nip/tuck; an episode I’m going to call…

Gynecomastia.

Cliff Mantegna is a swinger, and I’m not referring to his “woman-like breasts” (or “gynecomastia”). No, he attends parties where like-minded adults have multiple “relations” with strangers (c’mon, my family might read this). Before we go any further, no, Dr. Troy did not have “relations” with Cliff.

Basically, men’s breasts are really no different from women’s breasts – they both are made up of mammary glands; both are capable of producing and secreting milk; and, both are susceptible to breast cancer (please see my review of the episode, “Megan O’Hara“). And, just as I previously listed the many ways that women suffer from overly large breasts, gynecomastia can be an incredible source of stress for men, especially considering that the precise cause is unclear. Thankfully, for both women and men, there’s a plastic surgery procedure that can end the suffering – reduction mammoplasty.

Breast reduction surgery for gynecomastia is typically conducted on an outpatient basis. Prior to surgery, a mammogram might be recommended to check for breast cancer, as well as to reveal whether the enlarged breast is the result of extra fat, glandular tissue or both. During the 2 hour procedure, the patient is placed under general anesthesia. The plastic surgeon will then remove glandular tissue, fat, excess skin or all three. Liposuction might be utilized, as well. Regardless, the end result is eventually a firmer, flatter, more “masculine” chest.

Upwards of 50% of men suffer in some way from gynecomastia. If you’re one or if you know of one, please let them know that male breast reduction can help. They don’t have to suffer.

Me? Well, the suffering continues next week with another episode of nip/tuck.

See you next time.

Charlie Sheridan

Medical Editor and Consultant

Finally, a nip/tuck episode that addresses a plastic surgeon’s code of ethics! Can’t wait. So, let’s do this. I’m going to call this episode…

WHO THE HELL’S WRITING THIS SCRIPT!

Like all medical doctors, plastic surgeons adhere to a strict code of ethics. As I was casually reviewing the American Society of Plastic Surgeons’ Code of Ethics again yesterday evening (it was a slow night… nip/tuck didn’t help), I noticed that it states, among other things, that a plastic surgeon shall, “render services to humanity with full respect for human dignity” and that the industry should, “… safeguard the public and itself against physicians deficient in moral character or professional competence.” Uh-oh. I wonder if the Writers Guild has a strict code of ethics? Hmmm.

Anyway… just a hypothetical here, but let’s say a man comes in looking to have a lesion or birthmark removed, as Michael Shannon happened to do in this episode. And, let’s say that the spot he wants removed is located on a certain, well, delicate spot of the male anatomy. Not a problem. In fact, laser spot removal is so common and so successful at removing lesions including port wine stains that Dr. Troy, as usual, guarantees satisfaction, saying the spot will be gone before Mr. Shannon’s honeymoon. By the way, the code of ethics can take disciplinary action against any plastic surgeon who, “… guarantees satisfaction.” Oh, yeah, I almost forgot; this man – Michael Shannon – is actually Father Michael Shannon, a priest who’s looking to have the “identifying mark” removed because he’s being investigated for sexually abusing children of his parish. Hey, happens everyday! The removal of a birthmark, jeez.