One year without posts - was too busy with projects in plastic surgery, clinic management and investments into Brazil.
Recently I reviewed plastic surgery statistics for 2013, trends remain the same:
- people of all major (minors too) genders run away from aging  facelifting anything on their bodies and buying trendy anti-ageing proceduders: 31% increase in the US comparing to 2012;
- women still inject poisons into lips and foreheads: 15-20% increase globally in 2013;

- men pay more attention on anything happen on their faces: ...% increase for rhinoplasty, eyelid surgery and facelift.  

I seems plastic surgery in one of those, non-vital for human being activities, will remain grow during life long (just discovered) economic crisis.  People  will always buy bread and make facelifting... 

Run from crisis, run

This is rather offtopic post. I research plastic surgeries, but financial crisis, inflation and other apocaliptic scenarios is of some interest, so I tries to imagine what may happen if natural resources vanish and people start fighting for bread. Presumably "fighting" is not relavant for some regions and I tried to identify them. Brazil seems the most attractive solution for relocation, because it has abudant natural resources, land, attractive climate... OK. I am hurry too much.

So you are concerned with financial crisis, coming oil and food deficits and plan to change country of residence… In many European countries economic problems just evolve and soon will exaggerate. As such, in those countries debt is so out of control and have so high fraction of GDP, that they threaten to bring down the Euro:

Portugal 93.3%
Italy 118.4%
Ireland 94.9%
Greece 144.9%
Spain 61.0%

I do not mention the US, the major world supplier of paper money in exchange of real stuff. And the only reason creditors like China or Japan do not knock US doors asking take back paper is they are afraid such situation even more than the US.

So, probably it’s time nowadays to move to place where resources are abundant, political system is stable and you can be sure you and your kids will have own barrel or oil and piece of bread ?

It's a tough question, but there are a few things to keep in mind.

First, this is economical growth. Country with high rates of GDP growth shows potential for creation of new business venture or finding a job. China wows the world with double-digit economic growth, and Argentina, Uruguay, Paraguay, Brazil show tremendous rates of 7-10% Gross Domestic Product growth during the last decade. Brazil has become the world's seventh largest economy, on its way to displace the U.K. as the sixth.

Secondly this is resources. Most developed countries do not have own natural resource, thus situation in the world will depend on how demand for such resources as oil, gas, coil, ore, etc, will be satisfied for those countries. At least because all of them spend a fortune for military expenses, and some of them are member of nuclear club. Sounds threatening… Yes, but it’s how things work.

Among countries, having abundant natural resources, Brazil demonstrates friendliness for such people, coming from abroad, as you: threatened, afraid of social or cultural differences... Of course you can also move to other naturally rich countries, like Russia or India. There are places in Russia where people speak exclusively Chinese… just because all Russians moved out or died...

So, do not expect apocalypse will solve problem of selection new home. Make own choice, the world is all round.

Countries where plastic surgery is most demanded

I wanted to compare countries with the highest rate of plastic surgery operations per capita. For a first glance, it should be US, EU and Japan, as the most developed countries, with the highest income per capita. Plus, plastic surgery was invented in the US and this country should be somewhere on top. And this was true a couple of years ago, when the US, according to ISAPS Global Survey ranke 1st with 3,031,146 surgical and non surgical procedures in 2009.

Yet, nowadays we see incredible changes in this statistics with South Korea on top.

Top 5 plastic surgeries per capita

Country/Year	2009	2010
1	USA	South Korea
2	China	Greece
3	Brazil	Brazil
4	India	Italy
5	Mexico	Colombia

Surprisingly, are 3 countries from South America on top 5, and only 2 from EU. Probably hot sun and blue sea i stimulate demand for plastic surgery procedures and operations in Brazil. I should check, at least Brazilian lifestyle and food. The most popular operations were Botox injection, Breast augmentation, blepharoplasty, or surgery of the eyelids.

Is it possible to increase breast with own fat

This is one of the most important questions woman may ask plastic surgeon - is it possible to transfer fat from one area of my body to breasts. Although technology of fat transfer has become popular recently, and offered in European and US clinics, there are rumors about low universality and usability of this technique.
First of all, fat transfer or breast enlargement with own fat is recommended for patients after breast amputation: when there is no breast at all.
Secondly, this technique requires pre and post operative preparation: physical exercises, massages, etc. So, procedure is not easy comparing to breast implant operations: cash and carry.
If there's someone who made such operation and can share opinion, I would be really grateful...

Marketing mix for plastic surgery

The point of marketing is to make masses ready to buy your product or leastwise to identify true product to sell. Marketing is all around models. Disregarding of what do you perform, selling goods and services, you need to know and use proper pattern

4P’s “Product, price, promotion and place” or marketing mix. The similar model is 4C- context, competition, customer, cost. It’s trendy also today to bring 5th component like “people”” to pattern to show “social responsibility”. These patterns are essence of marketing and applied to nearly to any activity, from preparing marketing plan to analysing sales resultants.

Product in theory is a real value for client. In reconstructive surgery the value can be youthful and athletic body, changes in vocation or intimate life, betterment of inbred flaws, etc. It's amusing, reconstructive surgery is an outstanding instance to show what is the Product in Marketing Mix framework. Numerous people do not realize this right and believe Product is a list of characteristics. And you can realise reconstructive surgery as a Product unquestionably can't be described as a listing suchlike : unproblematic procedure, progressive technique, or short convalescence . Scarcely somebody pays for operation exactly because it is pain-free or carries any other feature. Hence here we meet the requirement to understand the customer and his necessitates, but not to show product. That's why 4P is closely connected to 4 C with Customer as an integral component.

Promotion brings Product to the marketplace and supports it there. As it may be transparent, 'brings' relates to new products and 'keeps' - to present ones. Promotion is the most innovative component of marketing mix and may stick with another model : AIDA (Attention, Interest, Desire, and Action). This means, that promotion medium should :
- attention,
- create interest which transforms
- to desire to purchase and
- occurrent buy.
You may see Promotion in varied kinds :
- Coke strong promotion with ultimate goal to make mental image of this beverage as a default option;
- Cosmetics direct promotion with ultimate goal to form a net of allegiant buyers, without expending a cent for mass media advertisements;
- Food supplements quiet promotion by local MD with final goal to give this stuff to patients to the end of days.
In reconstructive surgery Promotion is closely attached to life style and may imply not just advertizing of clinic, but even founding of passion for perfection. The Like it may occur with many Goggle Box worshippers aft 'Extreme makeover'. Promotion in plastic surgery creates wide area of opportunities for smart and aspiring marketer. Obviously there’s divergence between ‘Drink Coca Cola’ advertise and advertising of breast enlargement technique. In the initial instance you figure out on how the goal would be accomplished, while at the 2nd, for instance, you should firstly convince potential client he needs lipo the least bit, the second that he needs to buy the most actual presents infrasonic Liposculpture, and the 3rd he will buy it from your company.

Price is about money customer is willing to give for your goods or services. Pricing mainly is the following:
- cost based, - customers are non price highly sensitive, there is rivalry on marketplace and it’s hard / expensive to define market value. Despite the fact that cost based pricing is verbally often resisted by marketers, really it comes out even more often than some other types of pricing: prices for food ( bakery, veggies, fruits), tools and instruments, home gadgets, etc.
- market based, thought to be accurate pricing, when seller looking at on price level of suchlike products, powers to create or promote extra economic values of product, position in product life cycle. Product life cycle is a diagram, consisting from product periods : institution, maturity and decline. In introductory period margins can be higher, during maturity - stable, and while decline- decreasing.
Plastic surgery is more about market based pricing, because masses rarely employ price as the single factor to select plastic surgeon. Yet, clinics may try to minimize costs and create locations in low cost countries like Thailand or Estonia, and nevertheless charge premium for supplementary benefits like placement in playgrounds or intimate aura far away from relatives or paparazzi.
If we apply concept of product lifecycle to plastic surgery, we may discover it in maturity phase with extensive competition and comparable pricing, even among various countries. When was introductory phase ? I would say, in sixties when one American operating surgeon 1st made suction lipectomy with scalpel to his wife. This fact made plastic surgery a consumer product, since liposuction is the most popular cosmetic surgery from all others: facelift, breast enlargement, tummy tuck, etc. However, some people may debate saying examples of plastic surgery in ancient Egypt or Rome. However this clause about marketing for plastic surgery, not for history, and I even was lazy to look for name of the 1st operating surgeon who produced lipo.

Place is how do you distribute the Product. In several instances it can be even more important than Promotion, Product or Price (all parts of marketing mix are equal, but several might be more equal than others). Illustration from my life is chain of bakeshops, producing terrible bread, but having kiosks on high traffic places crosswise city. Essentially people have choice to buy breadstuff elsewhere, but purchase rubbish from kiosk to save time. Other instance is soft drink you may got in McDonalds; at that place will be no surprise in any eating house worldwide. Distribution represents very important function in retail, particularly if vendor does not have space for inventory, or demand is high, like it occurs with breweries in summer time. Some companies, especially in Japan, do not have stock at all, leaving supply for distribution.
In plastic surgery Place is a really sensitive matter and closely linked to:
- your target patient base, which means clinics can not direct famous people if based in blue collar area;
- constructing trust to clients. Like in case with banking companies, which must demonstrate substantiality and stability to those who loan them money.

The Second Revolution in breast enlargement

The 1st Revolution in breast enlargement was carried through by US cosmetic surgeons F. Gregow and T. Cronin who employed silicone implants filled with salt solution or silicone gel. The canonic technology of breast enlargement stayed the identical and only materials and varieties and sizes of implants change.

Nevertheless, implants were not as great as people wish and it’s not possible to reach desirable effects in 100% causes of breast enlargement procedure. The ground primarily not implants themselves, but diversity of cases why client want to increase breasts. For example, if breasts were lost after amputation because of cancer, implants can make the desirable shape, but on that point will be no touchable senses because implant is simply determined by touching. This is peculiarly dissatisfactory, regarding the fact that implants are viewed as a external tissue by your physical structure ( although with long-lasting warranty in respected clinics). According to many operating surgeons implants are required to replace for new in 13 -16 years.

The Second Revolution of breast enlargement occurred when system Brava Breast Enlarger, originated by American surgeon Roger Kuori was applied for preparation for breasts enlargement with personal fatty tissue (fat grafting).

Advantages of breast increase with own fat tissue (3D fat grafting):
- adipose tissue does not cause unhealthy responses in a breast, - adipose tissue is natural by touch,
- fatty tissue does not require replacement in the future.

I think the most perspective utilisation of this system is to restore amputated breasts because of cancer.
Let's consider differentiations between different methods of breast enlargement. Breast implants pluses :
- Proper for the majority of patients to increase and correct the form of breast;
- Effect reached quick;
- It is not essential to have some preoperative preparation.

Breast implants minuses
- Replacing in 13-16 years is requisite;
- Chance of complicatednesses, though not as large, but is present;
- Requirements for thickness of tissue;

3D fat grafting (breast enlargement with own fat) pluses
- No complications;
- Normal breast;
- Substitution in future is not required;
- Proper for all patient roles including those with cut off breasts;
- Realizable to use adipose tissue from liposuction areas.

3D fat grafting (breast enlargement with own fat) minuses
- Long-term preoperative preparation;
- Several procedures to produce.

As you can see, two methods of breast enlargement are not mutually exclusive, and can append each other. Also, combining of Brava Breast Enlarger and 3D fat grafting represents more opportunities to reach the best resultants in creation of a pretty breast. You can try such combination in Villa Medica clinics.

Russian plastic surgery is dangerous

Today, plastic surgery remains one of the most unregulated areas in Russian health care. However demand increases and the number of problem cases, some of which are fatal: just the other day led to the death during trivial liposuction.

Russia is booming plastic surgery. Paradoxically, this is not the richest country in Europe, however Russia stands at fifth place among countries with the highest level of plastic surgery operations. Today, market players are already talking seriously about the seasonal increase in demand for such operations: during summer season the number of clients in local clinics traditionally increases.


Russian market of plastic surgery is relatively young. Most of private clinics were opened only in the late 90-s, as well as a separate market segment of plastic surgery. It is right to say that until last year Russia even did not have specialists in plastic surgery.

A real top professionals with experience back to Soviet times are located mainly in Moscow , and come from reconstructive and rehabilitation departments of major medical centers .

The fact is that in Soviet times, plastic surgery was not known. Only the largest hospitals had offices of reconstructive surgery, where plastic surgery performed only by medical necessity - for example, for recovery from serious injuries or accidents. At the same time, most of the procedures that in the public mind are strongly associated with plastic surgery (face lift, wrinkle removal..) in fact, belongs to the so-called aesthetic surgery. Similar manipulations in the former USSR were carried out only in one place - in the Institute of Beauty on Novy Arbat, Moscow. However, to get there, patient was required to have medical prescription. It was impossible to call the clinic simply because the patient did not like his nose.

As a result, the market of plastic and aesthetic surgery in Russia during the past years was developed spontaneously or chaotically. It is illustrative to to say that even today there is no official statistics on the number of officially registered health care institutions providing plastic surgeries. There is also no exact data of how many and what kind of operations conducted were in Russia. The cardinal change in the situation occurred only last year, when Health Minister officially introduced a profession of "plastic surgeon".

"Today in Russia there is practically no legitimate plastic surgeons certified. In order to do this we need to take appropriate educational standards ", - states the head of reconstructive surgery and microsurgery of RNTSH, Academician Nikolai Milanov.

While officials and the official medical community still wonder how the system would operate training and certification of future plastic surgeons, thousands of professionals already working for many years throughout Russia, creating a private clinic and taking patients. Nowadays Russian media are full with advertising of such institutions with each of these naming themselves as "leading" industry experts. In reality it often turns out that a significant number of such leadears are surgeons, who made appendicitis cuts in local city hospital.

The result of this situation are numerous unsuccessful operations, despite the fact that Russian world of plastic surgery is so closed that even today there are no official statistics on the number of operations, and on number of the fatal operations. In early June, we received information about 27-year-old Louise S., who died after banal liposuction procedure. However legal consequences of this are still not clear, since according to law, criminal proceedings will be possible if medical examination would conclude that the woman died as a result of medical errors. So far, the autopsy showed that the patient died because of an allergic reaction to one of the drugs used for anesthesia.

The difficulty in investigating such cases is that the majority of patients before surgery did not take care about what they would do in case of failure and just easily sign a document with the words "warned about the possible risks."

In fact, "such informed consent" implies that a physician informs fully the patient about all possible risks. But in the pursuit of profit, most Russian plastic surgery clinics choose to bring to the information in the most simplified form, emphasizing the fact that these procedures are absolutely safe for health. Meanwhile, one should bear in mind that even a face lift has a very impressive list of contraindications.

According to the Moscow City Bureau of Forensic Medical Examination, about 7-10% of all civil cases against health care institutions accounts for unsuccessful plastic surgery. However, the success of the trial in such cases is highly questionable. To prove medical error patient must provide the results of medical examination conducted by colleagues of a surgeon who made a mistake. So to get objective results is not a simple task.