Friday, July 20, 2012

Mini Facelifts - LifeStyle Lift, QuickLift...


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Anyone watching television lately has been exposed to a mass marketing blitz by Lifestyle Lift. The infomercials claim over 150,000 completed surgeries and are filled with satisfied customers who in before vs. after photos look remarkably younger and happier after surgery. In 2012, Grammy®-winning singer, author, and television personality Debby Boone, best known for her 1977 RIAA Platinum-selling #1 hit "Theme from You Light Up My Life," became the spokesperson for the company in its television commercials and its half-hour infomercial; the song is well-represented in both the commercials and in the infomercial.

The ads promise “minor one-hour procedure with major results designed exclusively to improve jowls, frown lines, wrinkles, loose neck, and facial skin” that "requires no dangerous general anesthetic” and you can “return to work quickly compared to a traditional procedure.” They boast locations across the nation – in 42 cities and 22 states. The concept that is conveyed in this marketing is that this procedure is equally effective regardless of the surgeon doing it. Lifestyle lift is the company's name and is also a trademarked brand name used to market the procedure of the same name. Doctors sign up with the company and give a percentage of their fee to the company for performing their advertising. Prospective patients call the company or go to its website and are then referred to a nearby participating surgeon. The procedure itself is performed under local anesthetic and generally costs half the price of a regular facelift. Patients are lured in by the mass marketing, price and use of local anesthetic without general anesthesia (which is presumed to be riskier than local anesthetic). The model is high volume, low cost facelifting.

A regular facelift involves making an incision around the ear lifting or dissecting the skin off the underlying soft tissue in the neck and almost to the corner of the mouth. A variety of techniques are then employed to lift this deeper soft tissue of the cheeks and neck and the excess skin is removed from around the ear to yield the least noticeable skin scar, one that is hidden in the natural creases around the ears. Over many years after cumulative experiences of surgeons worldwide this became the standard facelift which gave the most reliable and longest lasting result.

Over the last few decades further modifications have been applied to the process to individualize it since no 2 people age exactly the same way. Beginning in the 1990s younger than previous patients began requesting the procedure. In these cases less aggressive surgery or only parts of the original procedure were necessary. The s-lift was born. In this procedure an s-shaped incision is made in front of the ear that extends under and in some cases around the back of the earlobe. The original s-lift involved a skin incision in front of the ear only and excising-suturing a deeper layer of tissue to give a tightening effect without elevating much skin as a separate layer by itself. The original procedure had little or no effect on rejuvenation of the neck. This was later modified by a number of physicians to include numerous different variations of the original procedure including pulling the deeper tissue upward using a suture tightened around the cheek bone. All are basically minor facelifts performed without doing all the steps of a full face lift. I personally do not use this misleading nomenclature as it gives rise to prospective patients asking for a specific procedure rather than asking for resolution of a specific cosmetic issue they want addressed. It has also facilitated incompletely trained or incompetent physicians to advertise their performance of specific procedures. They are incapable of going over the different procedures available with the patient much less performing those procedures. The lifestyle lift is basically an S-lift procedure with a neck tightening component including suturing tightening of a muscle in the neck. Instead of extending the skin dissection towards the mouth it is stopped a short distance from the ear and sutures with or without excision of deeper tissue near the ear are used to get a transmitted lift or tightening towards the center of the face beyond where the cuts are made. Some of the Lifestyle Facelift surgeons add procedures to the neck itself but in general  as a procedure Lifestyle Facelift adds nothing new to the armamentarium of facial plastic surgery techniques other than its marketing and reimbursement approach.  Other similarly trademarked lifts have appeared including "Quicklift", "The Weekend Facelift”, “The MACS Lift" etc. but none has been advertised to the extent of the Lifestyle Lift which has turned the procedure into a multimillion dollar business.

Almost since its inception LifeStyle Lift has been involved in multiple lawsuits. At one point the company sued Realself who had posted negative reviews as well as some positive reviews from LifeStyle Lift patients on their website. The allegation was that Realself infringed their patent by including the LifeStyle Lift name in their URL. Lifestyle Lift tried to use trademark law to wipe the negative reviews off RealSelf and keep them from influencing prospective consumers. Realself counter sued LifeStyle Lift for their employees allegedly placing false positive reviews on the Realself website. That case was settled with confidentiality agreements. Another company was sued by LifeStyle Lift for posting negative reviews on a webpage using a URL containing the term LifeStyle Lift again alleging patent infringement. The judge who heard the case dismissed it on May 2, 2008. In 2009 Lifestyle Lift reached a settlement with New York state over claims it had employees post false customer endorsements on third-party websites, including RealSelf.com, and on some 10 websites the company had created to appear as consumer generated praising of the procedure. Lifestyle Lift was ordered to pay $300,000 dollars to the state, and it agreed to cease the practice. In 2010, the Florida's attorney general office received more than 60 complaints about the company, including several contesting its claims about fast recoveries, minimal pain and results that take years off one's appearance. The office then opened an investigation to determine whether Lifestyle Lift's marketing practices constituted deceptive advertising by claiming its procedures were safer, less expensive, with faster recovery times than other types of facelifts. According to USA Today, Lifestyle Lift's advertising used the term "revolutionary" to describe a variation on longstanding face-lift procedures since the LifeStyle Lift did not really involve any new procedure other than the mass marketing of facelifts. In 2008, an Orlando, Florida facial plastic surgeon filed a complaint with the Florida Board of Medicine, seeking payment for emergency room services he provided to a Lifestyle Lift patient; the company denied that it was negligent in the case. The patient was "bleeding from the face" and needed emergency assistance with breathing and surgery for hematomas. The patient, who settled a lawsuit against Lifestyle Lift out of court, was in intensive care on a ventilator and breathing tubes for six days. Since the complications were the result of cosmetic surgery her insurance presumably did not cover the emergency room care, the surgeon was forced to treat the patient by federal laws and she likely had no more money after the lift procedure so the surgeon could only get reimbursed by LifeStyle Lift.

In July 2009 a Massachusetts woman had a seizure during the procedure presumably from the local anesthetic injection, was not hooked up to any continuous-monitoring equipment during the procedure, and no anesthesiologist was present. The medical staff did not know immediately how little oxygen she was getting. Forty-eight minutes after her first injection, the staff called for an ambulance. She was taken by ambulance to Mount Auburn Hospital in Cambridge,Massachusettes where her heart stopped twice and she was diagnosed as brain dead; she was deprived of oxygen for far too long. Her family took her off life support a week later and is now suing for wrongful death.

Now that there is blood in the water the sharks are circling and Meyerkord & Meyerkord, a St. Louis based personal injury and medical malpractice law firm, announced it is currently investigating claims related to the Lifestyle Lift® cosmetic procedure in pursuit of a class action lawsuit.

A Fort Myers, Fla., facial plastic surgeon, says he's treated several patients who were unhappy with the results they got at Lifestyle Lift. Most had "visible, poorly executed face-lift scars with no discernible aesthetic improvement," he says. USA TODAY interviewed six other plastic surgeons who did not want their names used but made similar comments.

The photography used in LifeStyle Facelift marketing is filled with variability using different angles, lighting, brightness settings, position, glamour shots, and laser treatments. The captions and narration often suggest some patients achieved the results in “about an hour procedure” under only local anesthesia. This is obviously false in many of the displayed cases. These practices may mislead thousands of prospective patients and use fear mongering of anesthesia as a selling point.. Disclaimers have recently been added to the marketing stating in fine print that patients pictured may have had “more extensive procedures.” This may have been in response to some of the litigation described above.

Although a min-facelift, LifeStyle Lift or other type of lift, may appropriate in some patients it is not appropriate for all patients just as local anesthesia alone is not appropriate for all patients. A great many of these procedures are performed under local anesthesia in non-certified operating rooms which can be very dangerous should the patient develop a problem during surgery. Although some patients are happy with the process and the results many patients complain of difficulty in seeing the surgeon after surgery, having legitimate complaints ignored, referrals to a national LSL complaint center and minimal contact with the surgeon prior to surgery as their presurgery care was provided by consultants. One of the top complaints is the lack of longevity of the procedure. Realself.com has gathered data from thousands of LifeStyle Lift patients, and found a 42% dissatisfaction rate, which is far higher than that described for private-practice independent plastic surgeons. The highly variable reviews of the LifeStyle Lift could be due to a one size fits all approach (the procedure is not for everyone), false positive reviews by the company (as they have a history of doing so), differences between actual surgeons or some combination of the above. Surgeons involved with the LifeStyle Facelift corporation have reported that there is corporate pressure to maximize conversion of consultations to surgeries. The ads would have you think that all surgeons performing a LifeStyle Lift and advertised on their website are the same but we all know that is not the case. It is the surgeon that is important not the name of the procedure performed or machine used at surgery just as it is the tennis player not the racquet that wins the tennis match.

Critics call this the commoditization of cosmetic surgery. Procedures that once included lengthy consultations with plastic surgeons and trips to the hospital, now often involve meetings in office-park surgery centers with salespeople who tell prospective patients what "work" they need and how little it can cost when performed in their offices as opposed to a private plastic surgeons office. The patients are pulled in by aggressive marketing programs on television the internet etc. This started some years ago with hairgrafting in the Bosley clinics and has spread to liposuction, facelifts, laser treatments and god knows what else. Proponents claim this way of doing plastic surgery allows those who otherwise would not be able to afford it to undergo cosmetic surgery.

While these clinics may employ plastic surgeons who are either board-certified or up for certification, lawyers, victims and other plastic surgeons say these new-style surgery clinics are under so much sales pressure they often don't sufficiently screen patients for medical problems, do inadequate follow-up and persuade patients to undergo procedures that are either unnecessary or unlikely to get good results. The surgeons work there because they have few other options in a long term recession where few have access to money and their case loads are disappearing to these heavily marketed companies offering steeply discounted procedures. I have personally witnessed this with one company who offered to hire me for liposuction procedures under only local anesthesia but would not let me see the facility until I signed a non-disclosure agreement. The facility had poor patient follow up, substandard operating facilities lacking emergency equipment, inadequate consent forms and other paperwork and high rates of patient dissatisfaction requiring revision. When I broached some of these issues I was suddenly persona non-grata and none of my calls or emails were answered. After some prodding they told me the job opening had basically dematerialized.

3 business models have arisen in this commoditization process. The first involves the surgeon working in the companies facility as an employee as in the Bosley model for hairgrafting and the Sono Bello model for liposuction. The second involves the surgeon using their own office to see referred patients like the LifeStyle Lift and Vampire Facelift. The third involves the company referring patients and stationing their own employees in the doctor's office like the American Laser Clinics. The end result to the practice of Plastic Surgery though is just as destructive.

Addendum June 16,2013:
LifeStyle Lift reached an agreement with the Florida attorney general to follow Federal Trade Commission guidelines on testimonials and to stop calling its face lift a "revolutionary procedure". It also agreed to refund money to some patients, disclose any compensation made to models used in its advertisements and other materials and state what facial rejuvenation services were performed on the models in company marketing materials. Now they are willing to admit that only difference is the use of local or twilight anesthesia rather than general anesthesia. It appears that some of the testimonial patients in the ads had more surgery than they admitted to and were compensated for their endorsements.They now add a disclaimer to their advertisements that there testimonial patients are compensated and are from various doctors so they are illustrative and do not constitute a promise or representation of any particular outcome. They still state that their procedures are done under local anesthesia so they are faster, safer more affordable. That is not true because in some cases local anesthetic is more dangerous than general anesthesia as evidence by the 2009 Massachusetts case and that fact that I almost every death case I reviewed for the Medical Board of California was a liposuction surgery done under only local anesthesia. Furthermore depending on the actual procedure it can take much longer to do surgery under local anesthesia than general anesthesia. Due to scheduling misunderstanding the anesthesiologist did not show for one of my liposuction fat grafting operations. I did the surgery under local anesthesia but the operating room time was double what it otherwise would have been as I had to wait for the local anesthesia to take effect without overdosing the patient.

Addendum October 29,2013:
More than 200,000 Lifestyle Lifts have been performed , but a large percentage of patients have been disappointed. In fact, over 1000 formal complaints have been filed. A recent Consumer Affairs report from a study they conducted reveals that the procedure had only a 2% full satisfaction rating with 5 stars, while the dissatisfaction percentage was 76%, earning only one star. So how can the American cosmetic surgery public be so gullible as to buy-in to a largely unpopular procedure?

It's all about external and internal marketing. Millions of dollars are being spent in television commercials and infomercials touting pleased patients with dramatic pre and post-operative photographs. In addition, once in the door of a Lifestyle Lift facility, patient counselors can be ruthless - employing a myriad of closing methods to book patients. These high pressure super sales techniques are not only leading to increases in Lifestyle Lift procedures, but costing ethical plastic surgeons millions of dollars in facial rejuvenation revenues.


Awake Surgery
Face and Neck Lift 1
Face and Neck Lift 2
Vampire Facelift is Really a Face Fill

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