In some respects cosmetic surgery is in disorder, there’s no doubt about that! The problem, however, lies not with cosmetic surgeons who were not trained as plastic surgeons but still perform cosmetic surgery. Why shouldn’t they do so? After all, general practitioners and doctors in other specialties were key proponents of cosmetic surgery long before there ever was a plastic surgery specialty, which incidentally has only been existence in Austria for 20 years or so. But neither can cosmetic surgery be reserved for plastic surgeons, as it is generally known that they have had no more cosmetic surgery training in their hospital internships than any other doctor. Hence the plastic surgeon, just like the rest of us cosmetic surgeons, had to attend the “training courses” that Prof. Turkof (whom I highly respect) rightfully advocated in the article entitled “The Beauty Battlefield” (Schlachtfeld Schönheit) in Profil 36/08.

To a much greater extent the problem lies in the fact that plastic surgeons tend to favor methods involving operations, as their training focused on reconstructive surgery after tumors and accidents. From a surgical standpoint, however, such methods often entail grandiose performances that are too invasive and stressful for the subtle improvements in appearance and body shape demanded in cosmetic surgery. Hand in hand with unrealistic alteration wishes (take Michael Jackson, for example), the result is a high rate of complications as well as many patients with an overly-tightened, unnatural look.

For the well-being of the patients, what is needed is a New Cosmetic Surgery in which operations are gentle and non-invasive, and wherein scalpels, silicone, and plastic are dispensed with as much as possible! This New Cosmetic Surgery must be entrusted to doctors with extensive medical training and capable of thinking across disciplines; ones who won’t resort to plastic reconstructive operations as a primary means for solving every cosmetic problem caused by stress and hormone deficiencies.

This New Cosmetic Surgery exists already: it is based on minimally invasive cosmetic interventions, autologous stem cells, and bioidentical hormones. It spares women undergoing breast and facial surgery from scalpels, plastic, and silicone, produces natural looking results, and means a substantial improvement in health and quality of life!

Hollywood does indeed set trends in many areas, but even in Hollywood the era of overly tightened doll faces and silicone breasts is coming to an end. Many stars are turning away from plastic surgery and swear by the gentler methods of New Cosmetic Surgery! Hence we can be cautiously optimistic that in the future there will be less bloodshed on the “beauty battlefield”!

Heinrich, MD

And they’re claiming that such a diet is healthy? Anybody who looks ill isn’t healthy! Among other things, a protein-deficient diet leads to insufficient quantities of hormones being produced. This not only causes the body to age faster, but also to die sooner due to lower resistance.

Many supposedly “natural” cosmetic and functional problems of aging are in fact symptoms of chronic deficiencies of certain hormones. A diet intended to slow down aging must therefore provide the nutrients, calories, and proteins needed for optimum hormone production. Furthermore, there is more and more evidence that intermittent fasting – as practiced in medicinal and religious traditions worldwide – may be advisable.

In New Cosmetic Surgery, we use bioidentical hormones to raise aging-induced low hormone levels back up to their individual optimum values, which frequently leads to a remarkable rejuvenation effect. Hence the widely-held assumption that rejuvenation is still an impossibility is not true – through the balanced use of bioidentical hormones, it can be achieved and experienced today! However, in some cases liposuction with microcannulas can help to get rid of the signs of aging. Aside from rejuvenation of the body, bioidentical hormones are one of the pillars of Weight Loss by DDr. Heinrich.

Heinrich, MD

This is a constantly recurring problem with silicone implants. Just a few days ago the director of a German clinic contacted me regarding a similar case. He asked me whether stem cell-enriched autologous fat transfer could help here.

Implants are obviously always palpable, in most cases also visible, and they stretch the breast tissue; it is necessary to explain to every patient that after a few years implants need to be replaced for the sake of appearance because of stretching of the breast tissue, and that follow-up operations must therefore be reckoned with. This means that if one doesn’t want oversized, soccer ball-like breasts, they must be tightened by reduction surgery in order to make them (restore them to) a reasonable size.

I believe that after surgical tightening there are two options for achieving a better appearance:

Breast augmentation using only stem cell-enriched autologous fat. Obviously the augmentation won’t be as impressive, but it will look a lot more natural. This would be the way to go if the patient is generally unhappy with her implants and wants to get rid of them at all costs.

Inserting new implants and attempting to fill out/round out the edges of the implants as well as the subcutaneous tissue in the breast/chest region with stem cell-enriched autologous fat. The augmentation by the implant is maintained without having to displace as much volume.

Because the only way to solve the problem of further tissue stretching by the implant is to refrain from more implants, I prefer the first option, even though the augmentation is less striking than with silicone. However, the breasts stay in shape and the patient can enjoy them for years to come without having to plan on expensive follow-up operations that are fraught with complications.

Shouldn’t silicone implants be dispensed with altogether? That is precisely the question.

Heinrich, MD

Amongst other things in the test, long waiting times for patients in the waiting rooms of various cosmetic surgeons were criticized. Waiting times are annoying, as everyone knows. They cannot be avoided completely, however, especially if the cosmetic surgeon is in great demand and tries to take a real interest in his patients. How long this takes depends on each individual case and cannot be calculated in advance.

For this reason, in addition to the normal appointments in my Clinic DDr. Heinrich we also offer VIP appointments at a higher price where there is no waiting time, and if wished these can also be outside of normal clinic hours.

In addition to this, the test brings up the old myth again that there is a special section in surgery that trains cosmetic surgeons. This representation is incorrect; numerous doctors who are general practitioners, dermatologists, gynaecologists, ENT specialists or have other specialised fields prove the opposite and are successful cosmetic surgeons.

There is of course no such thing as a “Board certified Cosmetic Surgeon”. The medical training in all specialist fields has the treatment of disease or physical ailments as its goal. Doctors of all specialist fields gain special knowledge of cosmetic surgery only within the framework of voluntary additional training. Here the original specialist field of the doctor is not the important thing, but the talents and focus on the techniques used.

In addition to this, cosmetic surgery is undergoing a change at the moment. Instead of treatments with scalpel and silicone under general anaesthetic, gentle and careful out-patient treatment is being done, such as liposuction with microcannulas or breast augmentation with stem cell-enriched body fat. The repertoire of the methods of this “New Cosmetic Surgery” come from various sectors of medical knowledge. Doctors who have undergone an interdisciplinary basic training and in addition to surgery have learnt to think also in terms of internal medicine will feel more at home here.

If you are interested in having cosmetic surgery, I advise you for this reason to check whether the cosmetic surgeon is a general practitioner with additional training in the field of cosmetic surgery and anti-aging medicine – in this case the results of your operation will probably be better without scalpel and silicone!

Heinrich, MD

Instead of liberal cuts with the scalpel, the “New Cosmetic Surgery” uses minimally invasive, gentle cosmetic operations under local anaesthetic; instead of silicone, stem cells won through microcannulation from the body’s own fat tissue, whereby, for example, permanent, natural-looking, silicone-free breast augmentation has long been possible as well as bio-identical hormones and growth factors!

If Mr. Clooney’s girlfriend had decided on a modest and completely natural-looking breast augmentation with stem cell enriched body fat, he is certain to have stayed with her. He would probably have asked himself why her breasts were larger and fuller without assuming that medical skills had lent a helping hand.

Heinrich, MD

Here I also had the opportunity of looking at photos of several mummies from this later era of the New Kingdom. They all looked as if they had been treated extensively with plastic surgery, Botox and fillers: no wrinkles, rounded features, yet lifeless, pallid and old. At that time the faces of cadavers had begun to be treated with various “fillers” before being preserved with powdered natron, in order to achieve full, wrinkle-free cheeks despite dehydration.

I am often asked why I do not offer Botox even though there is no doubt that it is a very effective therapy against wrinkles. If a face is treated with Botox and fillers over a long period of time, tissue changes develop which give the face an eerie, lifeless appearance similar to a mummy. Botox does not just paralyse muscles, which smooths out wrinkles, but it also makes the skin thinner, paler and drier, which means that it looks older. It particularly causes the glands of the subcutaneous layers of the skin to atrophy (an effect used in the treatment of excessive sweating of hands or armpits).

Is there an alternative in the treatment of wrinkles? Yes, New Cosmetic Surgery can indeed offer something better: growth factors. These are particular tissue hormones that are introduced into the skin by means of a special form of mesotherapy; and of course the therapy with the body’s own stem cells, won through liposuction with microcannulas! Both therapies have the effect of rejuvenating the facial skin, making it tighter and reducing wrinkles.

In spite of this, can it still make sense to use Botox in plastic surgery? Yes, for example, if facial movements need to be reduced for several months following surgery to encourage perfect healing in the facial area.

Many women would like to have been princesses in Pharaoh Shishak’s court, but very few would like to look like a mummy during their lifetime if they have the choice. For this reason I am optimistic that the new, natural methods will become accepted and that the mummy look will soon be a thing of the past.

Heinrich, MD

Through their hardness and weight, silicone implants stretch and cause wear in every breast to such an extent that after several years either a surgical tightening or a much bigger implant becomes necessary in order to prevent wrinkles and sagging. At some stage there is then a balloon, which in this case does not float but instead pulls the breasts down even more. This is where there needs to be some rethinking in cosmetic medicine. Plastic surgeons must  tell their patients what they can expect in the years following the implantation.

They can expect a breast that is a major construction site with several follow-up operations. As the complication rate with implant operations is said to be 8 to 10 % even with experienced plastic surgeons (which means that it is probably higher than admitted), you can work out what the probability of undesirable complications in 5 operations will be: ¹/₁₀ × 5 = 50 %! I can only appeal to your common sense – avoid plastic surgery for cosmetic problems whenever possible! Do not make your breast a silicone problem zone!

If you wish for breast augmentation, please use the more gentle methods of the New Cosmetic Surgery, breast augmentation with stem cell enriched body fat. This is of course somewhat more expensive than silicone, but consider the fact that you will need only one more injection at the most if your breast was originally too small for an adequate augmentation in one treatment. The complication rate is also much lower. With silicone, on the other hand, you are set up for about 5 replacement operations plus at least one tightening operation in the next 20 years, and you have a “good” chance of complications. And to be honest, who today thinks artificial balloon breasts are sexy? It is a known fact that George Clooney left his girlfriend because of 280 ml of silicone…

Heinrich, MD

According to the reports, however, the winners were not just the girls who had been “prettied up” with implants but also the plastic surgeons who had helped nature with their scalpels and silicone. One candidate had even undergone an operation to her toes in order to get apparently closer to the ideal of a “perfect body”. However, in the light of current trends and developments in the area of cosmetic medicine, this contest seems positively out of date.

There is no doubt that for some time the trend in cosmetic medicine has been going in the direction of restoration of natural beauty and health. In other words, a healthy body always radiates beauty too, and natural beauty can lead to a better sense of well-being.

The goal of New Cosmetic Surgery is increased beauty and health through methods that are as gentle and natural as possible. Breast augmentation through silicone implants and operative face-lifting can in many cases be replaced by treatment using the body’s own fat enriched with stem cells – the consequences are natural results without scars and foreign body implants. Stubborn fat deposits can be removed gently by means of specially developed and patented microcannulas; in many cases it is sufficient to set hormonal imbalance right by means of bio-identical hormones (Hormonal Regeneration®) to achieve cosmetic improvement.

On the other hand, anyone wanting to look particularly artificial can in future fall back on implants and plastic surgery. Whether the results will earn a prize outside of a Miss Plastic Surgery contest is questionable.

Heinrich, MD

It was inappropriate and incorrect that Dr. Holle, plastic and reconstructive surgeon, placed the blame for botched up cosmetic surgery on cosmetic surgeons who are not Board certified Plastic Surgeons. It was actually plastic surgeons who disfigured Michael Jackson.

Cosmetic surgeons who have specialised in plastic and reconstructive surgery have learnt surgically sophisticated and complex reconstructive operations during their training, and naturally tend towards a generous use of the scalpel, i.e. to perform complex and invasive operations. This, of course, is often unavoidable in reconstructive surgery following accidents or in the removal of tumours, but it is mostly “too much” in cosmetic medicine – also because the rate of unnatural results and complications increases greatly with invasive surgery.

Apart from this it is not true, as Dr. Holle maintains, that plastic surgeons learn cosmetic operations during their hospital training. Not one of the plastic surgeons working in Austria today learnt cosmetic surgery during their specialist training. This is also just as true of plastic surgeons in other countries, as we doctors know. Or would you allow a surgeon in training in a training hospital to perform cosmetic surgery on you?

All doctors who want to work in cosmetic medicine have to learn this initially in additional courses. Whether a plastic surgeon (like Dr. Holle), an ENT doctor (like Dr. Mang) or a general practitioner (like me). It is shown later who possesses the talent for this and whom the patients trust.

Heinrich, MD

There are still many misconceptions in this area of cosmetic surgery. Thus most cosmetic surgeons still do not know that the use of microcannulas (1.5–2 mm in diameter) make scar-free liposuction with a minimal after care of a few days  possible.

There are often controversial discussions on whether liposuction should be done before or after losing weight. My experience shows that it should be done beforehand, firstly because it makes further loss of weight easier and secondly because it creates space allowing the tissue to tighten up better during the subsequent weight loss. After a substantial weight loss the fat cells are so “sapped” that it is difficult to perform liposuction on them: they do not burst as easily as full fat cells when pierced by the liposuction cannula.

In many cases of weight loss, of course, liposuction is neither necessary nor effective. Only a consultation with the cosmetic surgeon can clarify things here. If you decide on this measure, however, then please have it done before your diet rather than afterwards.

Heinrich, MD