There are two major factors that transformed plastic surgery from the classic limited number of aesthetic surgeries to the current modern approach:
- Adaptation of Laser technologies for cosmetic medical applications
- A broader vision of beauty
- This produced treatments that were more customized
- Later, the treatments became more ethnically diverse
Historically, the Barbie doll was a very monolithic concept of beauty, not very much like real humans. Plastic surgery historically relied on classic Greco-Roman concepts about facial harmony and proportion. As we entered the 90â€™s and beyond, more customization and nuance in results were introduced into plastic surgery procedures. This will be discussed more extensively in Episode 3.
Lasers have been used in skin surgery since the 1960â€™s, mostly for vaporizing skin lesions or to cut tissue instead of using a scalpel. This took place at research and academic centers but was not a day to day part of dermatology or plastic surgery.
In the 1980â€™s a number of technological changes took place resulting in a flood of innovations in medical devices . One factor fueling this in an unintended way was the strategic defense initiative which was launched by the Reagan administration to develop lasers which could shoot down ballistic missile. Extensive funding was provided to national defense laboratories like Los Alamos and Lawrence Livermore for this purpose. The Strategic Defense Initiative was nicknamed the star wars program. After SDI was cancelled, national defense labs needed civilian uses for these technologies. Few of these actually ended up in clinical medicine but this accelerated transfer of innovative technologies from use in defense to civilian applications primed researchers in many fields to find worthwhile applications in other fields. Laboratory research data that had previously been of interest only to academic scientists was being re-examined for potential solutions to real world problems.
In the 1990â€™s the term translational research was coined but this activity was really taking place in the 1980â€™s in a big way. Lasers became faster and easier to make. The technologies transitioned from gas discharge tubes to sturdier, more compact solid state devices. Substantial advanced in our understanding of laser â€“tissue interaction spawned an explosion of clinical applications for lasers in dermatology and plastic surgery in the 1980â€™s and early 1990â€™s. Further advances in the 1990â€™s expanded these treatments to all skin types, not just light Caucasian skin.
Currently lasers are used for all manner of skin conditions. Other energy based devices have played an increasing role using energy sources such as radiofrequency, ultrasound, microwave and broadband light (not a single wavelength like lasers).
- Skin on the face, neck chest and hands are treated for redness, broken blood vessels, pigment changes like sun spots and dyschromia and wrinkles. Laser hair removal has revolutionized the treatment of large areas like the back and legs. Laser and energy based devices are used for skin lifting, laxity reduction and smoothing.
- Body skin smoothing and non-invasive treatment of fat are newer applications of lasers and energy based devices.
- Surgical procedures have been enhanced by advanced laser and energy based tools providing enhanced outcomes or more precision.Safety â€“medical treatments â€“supervised by medical personnel â€“risks are minimized. Still some risk but reasonable.
- Many transformations have taken place in plastic surgery over the last few decades substantially improving care for patients.
- There is a better understanding of individual beauty features, creating customized, not cookie cutter treatments and procedures.
- Doctors and patients are considering a much broader concept of beauty and more ethnically diverse.
- New technologies allow more complete rejuvenation than before.
- Treatments are less invasive with less recovery time.
- Laser and energy based treatments are medical treatments that must be properly supervised by licensed medical personnel. With proper patient selection and parameter selection for treatment goals and skin type, risks are minimal.
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Doreen Wu (00:00):
Welcome to this episode of the Park Avenue Plastic Surgery Class, the podcast where we explore different controversies and polarizing issues in the world of plastic surgery. I’m your co-host Doreen Wu. And I’m here with Dr. Lawrence Bass Park Avenue plastic surgeon, educator, and technology innovator. The title of this episode is Barbie versus star wars. The advent of laser cosmetic medicine, Dr. Bass. That’s a very unusual title that seems to have little to do with plastic surgery. When I think of Star Wars, images of lightsabers and mind reading Jedis come to mind. So what exactly does this title mean?
Dr. Lawrence Bass (00:42):
Well, you know, this is one of my favorite subjects. Um, in this episode, we’re going to talk about two major factors that have transformed cosmetic plastic surgery from what it classically was to what is being practiced today. The adaptation of laser technologies to cosmetic medical applications is one factor. That’s the Star Wars. And I’ll explain that in more detail and a broader understanding of different concepts of beauty, more ethnically diverse concepts of beauty and customization of beauty goals is the second factor. And that relates to Barbie who historically was a very monolithic concept of beauty that didn’t relate to the way many, many human beings actually looked and Barbie has become more diverse and come to a more real view of human beauty over time.
Doreen Wu (01:54):
I’m really excited to hear all about that. So let’s jump right in. It sounds like this first episode will be a story about lasers when exactly does this story start and how are lasers being used in medicine before that
Dr. Lawrence Bass (02:09):
Lasers have been used medically at least on skin and in skin surgery since the 1960s, but most of that was just vaporizing a skin lesion or using the laser to cut an incision instead of using a scalpel. So that was kind of the history of lasers, going back a ways and not much actual day to day clinical use for beauty treatments or for beauty surgery, cosmetic plastic surgery, but round about the 1980s, a number of technological changes took place that resulted in a flood of innovations in new medical devices, including devices used in plastic surgery
Doreen Wu (03:01):
And what exactly produced this new surge in all of the medical device innovations.
Dr. Lawrence Bass (03:07):
Well, and that’s really why I picked the term Star Wars because in the 1980s, the United States had this strategic defense initiative. Uh, the notion that they were going to use lasers placed on satellites in space, and orbit around the earth to shoot down ballistic missiles. And the nickname for that project was Star Wars. Um, so there was a surge of laser activity in the national defense labs. But there came a time when the former Soviet Union collapsed and the Cold War eroded and that project was canceled and the defense labs were sitting with all kinds of investment in technology and they wanted to continue their funding not lose their funding. Uh, so they started to look for civilian use for all of these military technologies. Now there aren’t really good examples of national defense lab technologies that are now being used in clinical medicine, but that set everybody in technology industries thinking about kinder, gentler applications for their technologies, healthcare applications, which are always of course, beneficial to the world society.
Dr. Lawrence Bass (04:35):
And that is really the rude example of translational research. What in the nineties became termed translational research, taking something from the bench to some real world use, where it could benefit people instead of just being theoretical knowledge and cross pollinating from one field to another, finding a use in one field where formerly it had only been used in another. And so for a lot of very technical reasons, lasers became faster to make easier, to make more reliable. And the, in the understanding of how lasers could help us with various skin conditions and aging changes in the skin was also better understood in 1980s. And so all of those things spawned this explosion of clinical application of lasers in the late 1980s and early 1990s.
Doreen Wu (05:39):
That’s really interesting. I didn’t know, lasers had such a, a fascinating and colorful history that originated from the national strategic defense
Dr. Lawrence Bass (05:51):
Doreen Wu (05:52):
Dr. Lawrence Bass (05:55):
Just think Star Wars and, and you’ll be good.
Doreen Wu (05:58):
So where have lasers gone from there?
Dr. Lawrence Bass (06:01):
Well, from there lasers really developed to be smaller, less expensive, solid state older lasers had a big glass tube that was filled with a gas that would be used as the laser medium in newer lasers. Just like things went from old TV tubes in the old TVs glass tubes in the back to solid state transistors. The same kind of thing happened with lasers. From there people started imagining more and more applications refining how the lasers worked and figuring out how to apply the lasers to a broader range of skin types.
Doreen Wu (06:49):
Now that we’ve learned a lot about how lasers have come to be. I wanted to ask about some of the lasers that you currently have in your practice and what patients are using and what the different uses for lasers have been,
Dr. Lawrence Bass (07:04):
Lasers are used for all manner of skin surface conditions. And now also for a variety of body skin contouring and skin smoothing. So things like redness on the face, broken blood vessels, pigment changes like age spots and irregularity in pigment. As we age the pigment on our face becomes less even a big application that’s not very common in doctors’ offices nowadays, but are very common in, in med spas is laser hair removal. And that’s tremendous in being able to treat large areas of hair, uh, that the before lasers got into this area, electrolysis was there and that’s really, really effective at getting rid of hair long term, but it’s very time consuming, done a single hair at a time. So if you have three hairs on your chin, electrolysis is brilliant, but if you’re trying to get hair off your, off your neck, you’re a lady who has almost as much hair as a man.
Dr. Lawrence Bass (08:19):
And some, some folks are like that and they’d like to get rid of it. That’s too time consuming. If you’re a man with a hairy back and you want to go to the beach without showing that, electrolysis just isn’t an option. So laser enabled that, but it really went on from there with a host of devices that are, that are good at ably skin, smoothing skin lifting, reducing fat in unwanted areas, noninvasively. So all of these options have now expanded out in, in these noninvasive, not just lasers now, but energy based technologies, because there are an increasing number of radio frequency devices and microwave devices that use those energy forms instead of laser energy, which is light to create a lot of the same tissue effects.
Doreen Wu (09:18):
Personally, when I think of lasers and all of these energy based devices, I get a little scared and I’m not sure how safe they are. Can you talk a little bit about how, um, in aesthetic medicine, these lasers and all these different devices, um, are being safely used?
Dr. Lawrence Bass (09:38):
So the key concept here is these are medical treatments. So it’s important that they be appropriately supervised by medical personnel and that a medical provider like a plastic surgeon or someone who is qualified by training and experience has examined. You diagnosed what conditions are present and determined the appropriate parameters that a device should be used with. And in that setting risks are very reasonable, very minimal compared to bigger treatments like surgical interventions, but they’re not zero. Everything we do has some level of risk, uh, but in experienced hands, uh, in, in a proper setting, uh, these are very safe treatments.
Doreen Wu (10:42):
Exactly. I feel like if I was to avoid all risk in my life, I’d probably never leave my apartment. So to, before we wrap up, it sounds like the world of plastic surgery and cosmetic medicine has undergone many transformations in the last century. What are some of the biggest changes that you have seen? And do you think therefore the better or worse?
Dr. Lawrence Bass (11:05):
Well, I, I think things are getting better. Um, we have a better understanding of how individual beauty features need to be addressed. So the treatments rather than being cookie cutter are more customized. We have a much broader vision of beauty. That’s not ethnocentric, but ethnically diverse. And this plethora of new treatments technologies allows us to be more complete in addressing beauty issues in rejuvenating the face, for example. And because we have all of those options, we can do things that are less invasive and involve less recovery time, which of course is always a good thing.
Doreen Wu (12:00):
Thank you, Dr. Bass. Well, this was a terrific episode and I know I definitely learned a lot about the history and application of laser treatments and other energy based devices in aesthetic plastic surgery. I can’t wait until the next episode where I can pick your brain on how you approach customizing treatments to your patients and how you avoid the cookie cutter approach in cosmetic medicine. This is Doreen Wu. Thank you for joining me and Dr. Bass for this discussion of Barbie versus Star Wars, the advent of laser cosmetic medicine in plastic surgery, be sure to join us next time, where we will explore the other big factor, transforming plastic surgery, how we customize treatments to match individual and ethnically diverse standards of beauty Barbie versus star wars. Part two,
Speaker 3 (12:50):
Thank you for joining us in this episode of the Park Avenue Plastic Surgery Class podcast with Dr. Lawrence Bass Park Avenue plastic surgeon, educator, and technology innovator. The commentary in this podcast represents opinion. This podcast does not present medical advice, but rather general information about plastic surgery that does not necessarily relate to the specific conditions of any individual patient. No doctor patient relationship is established by listening to or participating in this podcast, consult your physician to advise you about your individual healthcare. If you enjoyed this episode, please share it with your friends and be sure to subscribe to our podcast on Apple Podcasts, Google, Spotify, Stitcher, or wherever you listen to podcasts.