Plastic Surgery and Cosmetic Surgery: An Overview

Several people want to enhance their looks in any possible way, and reaching out to the Plastic Surgeon is their best answer. Often, they are not clear about the expert, whom they should approach, the Plastic Surgeon, or the Cosmetic Surgeon. The best way to understand this, is to know the definition and working of each surgeon’s expertise.

Plastic Surgery fundamentally means to mold or shape a body part using surgical procedures. It has various sub-divisions, which demarcate different specializations. The primary division of Plastic Surgery is the ‘Reconstructive’ surgery. It deals with the betterment of an abnormal body part, caused by an accident, birth defect or even cancer. Cosmetic Surgery deals with enhancing the appearance of a particular body part for aesthetic reasons, the reason why it is called Aesthetic Surgery as well. Hence, it is clear that Cosmetic Surgery is a part of Plastic Surgery.

Difference between a Plastic Surgeon and Cosmetic Surgeon

Since there is no specific residency program for Cosmetic Surgery, treating physicians come from different backgrounds. While the Plastic Surgeon primarily works as a Cosmetic Surgeon, an Otalaryngologist (head and neck surgeon) or a Dermatological Surgeon can also perform Cosmetic Surgery Aesthetics. In order to perform Plastic Surgery, the doctor has to undergo much more. At least two years of residency in Plastic and Reconstructive Surgery after General Surgery Residency is the bare minimum for a doctor to use the term “Plastic Surgeon” for his career. A doctor who calls himself a “Cosmetic Plastic Surgeon” or “Aesthetic Plastic Surgeon” without having formal training, in fact is unethical and misleading. The general public do not really understand the meaning, and without proper knowledge, can face major problems post operation.

Choosing between a Plastic Surgeon and Cosmetic Surgeon

It is a known fact that Plastic Surgery is a highly specialized job. Mere knowledge about the human anatomy does not entitle the credibility to any doctor to perform Cosmetic Surgery Aesthetics on a body part. General Surgeons have experience in performing appendectomy, mastectomies, hemorrhoidectomies and thyroidectomies. On the other hand, Dermatological Surgeons treat more of skin disorders, and are not trained well to treat skin lesions. It is not advisable to even choose the ENT specialists or Gynaecologists for breast augmentations, liposuction and facial surgery.

A major part of the job of a competent Plastic Surgeon is having proper knowledge of his duties if and when the post-operative wound does not heal normally. It is important to take immense care while treating difficult wounds and non-healing ulcers. After all, surgery deals with one of the most unpredictable gifts of nature: the human body. A Plastic Surgeon is required to expect the unexpected and proceed accordingly to cure the patient. So, choosing a Plastic Surgeon for Cosmetic Surgery is the most prudent decisions for any kind of changes in appearances. A good Plastic Surgeon will actually be the better judge of performing Cosmetic Surgery Aesthetics.

Dr. Thomas Fiala, M.D. is an expert Plastic Surgeon Duo, offering Cosmetic Surgery Aesthetics. Residents of Orlando, Altamonte Springs, FL can be hassle-free when availing their services.

For More Information on the Treatments and Procedures Offered, contact award winning Board Certified Plastic Surgeon Dr. Thomas Fiala at Fiala Aesthetics in Greater Orlando to Schedule Your Consultation:



Serving patients in and around Greater Central Florida: Orlando, Altamonte, Lake Mary, Maitland, Winter Park, Clermont, Casselberry, Lake Mary, Longwood, Celebration, Heathrow, Windermere, Dr. Phillips, Sanford, Deltona, Deland, Daytona Beach, Melbourne, Cocoa Beach, New Smyrna Beach, Tampa, Jacksonville, Sarasota and more.

Voted the #1 Best Plastic Surgeon in Orlando, Florida by the readers of Orlando Magazine.




At least 24 people in Hawaii have developed acute non-viral hepatitis after using the dietary supplement OxyElite Pro, marketed for use in weight loss and muscle building. Additionally, two patients have received liver transplants, and one patient died, but it is not clear whether they took OxyElite Pro or a different dietary supplement.

The cases (median age, 33) all lived in Hawaii, but the CDC is investigating whether there are cases of liver injury elsewhere, since the supplement is sold nationwide. The FDA advises consumers to stop using OxyElite Pro during the investigation.
Bottom line:  Dr. Fiala does not recommend OxyElite Pro or similar non-FDA approved dietary supplements to his patients. 
portions reprinted from New England Journal of Medicine online Journal Watch; Kelly Young – author.

Contact Board Certified Plastic Surgeon Dr. Thomas Fiala at Fiala Aesthetics in Orlando to Schedule and Appointment:

For more information of the treatments and procedures offered at Fiala Aesthetics Plastic Surgery Center & Orlando Medical Spa by Dr. Thomas Fiala please contact us here.

See plastic surgery procedure and treatment price list.

Serving patients in and around Greater Central Florida: Orlando, Altamonte, Lake Mary, Maitland, Winter Park, Clermont, Casselberry, Lake Mary, Longwood, Celebration, Heathrow, Windermere, Tampa, Jacksonville, Sarasota and more.

Voted the #1 Best Plastic Surgeon in Orlando, Florida by the readers of Orlando Magazine.





This week a patient came to my office, and told me about her treatment here in Orlando with a gadget called the Lipotron 3000. It’s advertised as being a radiofrequency machine that can melt both subcutaneous and visceral fat, and is promoted as part of a weight loss treatment called Lipo-Ex or LipoFast. It’s also called the “non-invasive radiofrequency assisted lipoplasty”(RFAL) machine.My ears immediately perked up – because this machine is well-known in our industry, but not in a good way. Turns out, the Lipotron 3000 is not FDA approved as a fat melting or weight loss machine. While it does use radio-frequency energy, it flunked the FDA approval process in 2007 and again in 2008-2009. Its only approval is in the much more limited “massage machine” category.

Nevertheless, its manufacturer is promoting it for fat loss and weight loss, which is way outside of that category. The FDA is not at all pleased with this flaunting of the law, and has told the manufacturer, RevecoMED, to cease and desist. (see FDA letter here)

So, please beware: several spas and weight loss clinics in the Orlando area use this device. It’s a sham – it does not melt visceral fat, and is not even particularly good at tightening skin or melting subcutaneous fat.  Buyer beware.

For more information of the treatments and procedures offered at this Orlando Plastic Surgery Center & Medical Spa by Plastic Surgeon, Dr. Thomas Fiala, please contact us at (407) 339-3222(407) 339-3222 or visit:

Every few years, there seems to be a return of an old concept that didn’t work the first time around: trying to lift a droopy (ptotic) breast with internal sutures. This was first developed around 2001 by the Bulgarian cosmetic surgeon Serdev, who applied internal suture lifting techniques to almost every part of the body with fairly limited success. After a brief flurry of interest, we thought it went the way of the dinosaur…

The idea sounds so appealing: put in a couple of sutures to lift or tighten an area, and voila! It promises very limited incisions and scars, and can be done under local anesthesia. Ads trumpet “instant results”…. Sounds too good to be true, right?

The problem with suture suspension lifts in general is that the results don’t last. In the face, research has shown that suspension suture techniques last maybe a year at best when applied in the face. In the breast, there is very limited research (i.e. nothing published in reputable plastic surgeon journals!) showing that the technique even works at all in the breast, even if you anchor the sutures to a fixed point like the clavicle. You can’t reasonably expect one suture to hold up an entire breast – as the weight of the breast causes the suture to cut through the tissue, like a wire cutting though a block of cheese, a little at a time, until the lifting effect is gone. Internal scarring and odd distortions of the skin are other side effects that occur with this method.

So, dear readers, this technique of the suture lift is highly “experimental”. Although some surgeons locally do perform it, I can not recommend it at this time. If you decide to have this done, make sure it is under the auspices of a properly-run, IRB-approved medical study.

There is, however, another method of making the breast look better with virtually no scars: fat grafting. But that’s a story for another time…

While the smartphone is pretty impressive technology, turns out that melanoma diagnosis apps are still pretty dumb – and inaccurate.

A new study, published in JAMA Dermatology this week found that 3 out of 4 apps incorrectly labelled at least 30% of actual melanoma skin cancers as “unconcerning.”

Four smartphone apps marketed for analyzing skin lesions were tested by researchers at the University of Pittsburgh Medical Center. A photograph of the suspicious skin area is taken and uploaded by the user, and the app is supposed to tell whether it is a potential melanoma or a cause for concern. The study used photos of skin cancers and benign lesions where the identity (cancer or not) was already known, and checked the apps for their diagnostic skills.

The app that seemed to work best was the one that sent the images directly to a board-certified dermatologist for his/her opinion. The lowest sensitivity was in apps that used computer algorithms to try to analyze images. Of the 3 apps that did not involve a physician, even the best one was wrong 30% of the time. The worst performing app only got it right 6.8% of the time!

So, smartphone apps are not a substitute for a real dermatologist – at least, not yet. The concern is, of course, what happens to the person that uses one of these inaccurate apps who actually has a melanoma, but is lulled into a false sense of security because the app said the skin lesion was supposedly “benign”. Currently, there’s very little regulatory oversight for these programs.

Take home lesson: learn the ABCD’s of melanoma. (Asymmetry, Border irregularity,Color that is uneven, Diameter > 1/4 inch) If you have a suspicious mole, go see a dermatologist.


Here’s an interesting story from NBC News. Seems that the FDA isn’t too happy about unapproved Botox coming across the northern border…
For the consumer, the take-home message is this: if the price of the “Botox” you are getting seems too good to be true, maybe it isn’t really genuine, FDA-approved Botox, sourced from Allergan. It could be faux-tox from who-knows-where! Ask to see the bottle or the box it came in.
WASHINGTON — Federal regulators have warned more than 350 medical practices that Botox they may have received from a Canadian supplier is unapproved and could be counterfeit or unsafe.
The Food and Drug Administration said in a letter sent last month, a letter released publicly last week, that batches of the wrinkle treatment shipped by suppliers owned by pharmacy Canada Drugs have not been approved by the FDA and that the agency cannot assure their effectiveness or their safety.
The FDA said Canada Drugs was previously tied to shipping unapproved and counterfeit cancer drugs.
The agency warned doctors about buying drugs from sources other than licensed U.S. pharmacies. It is the fifth warning the agency has made this year about foreign suppliers providing unapproved drugs.
A request for comment from the drug distributor was not immediately returned.

Ulthera is a new non-invasive skin tightening device. The idea seems promising:  use intense focused ultrasonic energy to target tissue deep to the skin, heat and coagulate the tissue, thereby getting some tissue shrinkage and tightening.  It’s had great press on the various TV talk shows.  It is FDA approved – so we know it’s safe.  The question is:  does it work?

This week, at the famous Baker-Gordon plastic surgery symposium in Miami, Dr. Jeff Kenkel from Dallas reviewed his experience with the machine.  It wasn’t good.  The treatments were painful for the patients.  The results, using the standard protocol, were hard to see in the neck and face, even comparing side-by-side before and after photos.  The Ulthera treatment, however, did seem to work to give a subtle lift of the eyebrow area.(average lift :1.7 mm).  It was, in my opinion, underwhelming.

Nevertheless, Dr. Kenkel and his group are going to press on, and are in the process of developing a new treatment protocol to see if they can get some improved results in the face and neck…   Honestly, I’m glad I didn’t purchase that machine – I think I would have been very disappointed with the subtle results that were presented.  I suspect that many of my patients would feel the same way:  they expect more results for their money.

Although this doesn’t apply to us here in the U.S., you might remember hearing about some troubles with the French implant maker PIP.  The news initially broke last year that PIP had been using a cheaper industrial grade silicone in their silicone gel breast implants, rather than medical grade silicone.  They were promptly shut down by French regulators.  Now, there’s some more news…

This week, the French health ministry said that these PIP brand implants were much more prone to rupture and leakage than normal, and recommended implant removal (and replacement with new, better implants) as a precautionary measure.  They stated there was no evidence of a cancer link due to these implants.  The French government says it will cover part of this cost for patients under their healthcare plan.  (They’ll pay to have the implant removed – but not to replace it.)

It is thought that some 30,000 French women, and even more in other parts of Europe and South America have these PIP brand implants.  That’s a lot of patients who are potentially going to need surgery.  PIP, now bankrupt, was once the world’s #3 manufacturer of breast implants.

The implants we use in our practice, made by Allergan and Mentor, are FDA-approved, and have an excellent track record.  I’ve been to the Mentor manufacturing facility in Texas, and it is a top-notch facility run using ultra-sterile “clean rooms” with the employees in those “Intel-inside” type sterility suits.

Fortunately, PIP implants were not used in the United States.  However, if you happen to have had your breast implants done in Europe or South America, check to see if you have PIP brand silicone implants.  If you do have them, please come and talk to us about an implant exchange.

There are two great products for skin care:  Retin-A and sunscreen.

With the upcoming Thanksgiving holiday fast approaching, I was reminded of a certain educational poster about the need for sunscreen and sun protection….I hope you find it as funny as I did!

Poster: S Cooper, “Baking is for Turkeys”

The allure of instant contouring of the buttock or breast with an injectable filler is pretty strong.  It sounds like such a promising concept – a few quick injections, no invasive surgery – and voila!, instant shaping.  Search the internet, and you’ll see lots of sites about hydrogel injections for instant buttock augmentation.

Question:  what injectable material can be used to do this safely?
Answer:  there isn’t a good one yet.  Read on; I’ll explain.

The perfect filler would have to be 100% biocompatible – that it caused no reactions from the body, such as allergies, granulomas (lumps) or delayed hypersensitivities.  The filler would also have to stay where we put it, and not migrate.  And it would have to keep it’s original shape, and not be reabsorbed.

Combining these properties is a real challenge.  So far, we really don’t have anything that matches all the criteria, let alone passes FDA scrutiny.

So, what exactly is this hydrogel stuff?  A hydrogel is any gel-like substance that is mostly water.  Hair gel, ultrasound gel, Jell-o and KY gel are all well-known examples of hydrogels.  (But I don’t think anybody in their right mind would want to use those as an injectable product!!)  Some sort of chemical polymer, which is present in a small percentage, is responsible for gel’s physical properties.

Restylane and Juvederm are also hydrogels.  They are hyaluronic acid (HA) gels.  They work very well, have extensive research behind them and are FDA approved, but are temporary fillers, and are too expensive for large volume injection.

Outside the U.S., there are literally dozens of other hydrogel products, made with things other than HA’s. There’s a lot less scrutiny and regulatory oversite outside the U.S., so there’s been a huge proliferation of these fillers.  They are often advertised as being 100% biocompatible, but scientific research has shown that this is often not really the case, and sadly, that long-term problems do occur.

The hydrogel “Interfall” was developed in the Ukraine, in the early 1990’s.  It was the original polyacrylamide gel (“PAAG”).  It seemed like a great idea – and was initially quite popular outside of North America.  Interfall inspired a bunch of imitators – Cosmogel, Argiform, Amazing gel, Formacryle – and is still easily available on the internet.  With time, reports of major, unfixable problems came to light (link1) (link 2)(link 3).  I believe it’s still manufactured in China, although it’s been banned from use there since 2006.  In any event, it’s not FDA approved, and I certainly wouldn’t recommend it….even though you can get it on the Internet.

Although newer, supposedly better, generations of PAAG fillers have been developed, we’re still not sure that they are trouble free.  For example, Aqua-lift, a Russian hydrogel filler product, had a major product recall as recently as December 2010.  Longterm studies on the safety of Aqualift are still pending.

A Danish product, Aquamid, is currently undergoing FDA review.  Safety data out to 24 months looks OK, but that is still “early” when you consider that aquamid is a permanent product.

Bottom-line:  One day, we’ll probably have an injectable hydrogel product that actually works safely and effectively.  But that day isn’t here yet.  Until these filler materials pass American testing standards by the FDA, do not use them for breast, buttock or other soft tissue augmentation.  No reputable doctor injects these materials.  Just say no.

Fat injection or buttock implants are currently the only FDA approved methods for buttock augmentation.

Fiala Aesthetics | Plastic Surgery & Med Spa