Month: March 2016

In the 19th century, purveyors of snake oil elixirs purported their potions would treat a variety of complaints. Rheumatism, kidney issues, and even “female problems’ were all treatable by these cure-all potions.

The creation of the FDA (Pure Food and Drug Act 1906) under President Teddy Roosevelt should have put an end to such unsupported medical claims that defrauded the consumer. Yet today modern scientific terminology is being used to market creams and even invasive procedures without scientific studies to prove they work.

The Truth About Platelet Rich Plasma

Platelet Rich Plasma (PRP) is being touted as a fountain of youth. Platelets are cells produced in the bone marrow that are essential in forming blood clots. PRP is derived by drawing a patient’s blood and spinning it in a centrifuge to separate the portion containing the platelets. There is no requirement to check the actual concentration of platelets in the PRP. 

Procedures developed by an internist in Alabama, (who was previously cited by the Alabama Board of Medicine for improperly prescribing estrogen and thyroid hormone) use PRP injections to perform nonsurgical face-lifts, breast lifts, and treat both “male and female problems”. 

Taking a page from the snake oil salesmen (snake oil was also called “patent medicine”), the creator of the “P” (PriapusTM) shot for male enhancement, “O-shotTM” (Orgasm) for vaginal dysfunction, the Vampire Breast LiftTM, and Vampire Face-LiftTM has trademarked the terms. He then sells licenses to doctors, nurses, or others to use the names for PRP injections for $997 (to join the American Cosmetic Cellular Medicine Association which he created) along with a $97 monthly fee. For a mere additional $4897 the doctor or nurse can learn the technique directly from the creator himself in a 1½-day course.

So how do these “procedures” work? Quoting from the inventor’s website (vampirebreastlift.com), “first the injector (1) isolates growth factors from the patient’s blood (italics in the original). (2) When these growth factors enter the breast (injected by the physician), then multi-potent stem cells become activated to grow new tissue. This new tissue includes collagen, new fatty tissue (for smoothness), and new blood vessels (for a healthy glow). These growth factors work like magic to cause increased collagen & new blood flow. (3) Injecting the Magic into Your Breast…These growth factors then activate multipotent stem cells already in the skin.”

FDA Regulations to Come

The FDA has announced that the era of unregulated and unsubstantiated claims for stem cells is coming to an end. The Agency is holding hearings in April 2016 to develop new regulations to protect patients from practitioners who use scientific terms to lure unwary consumers.

With April 15th rapidly approaching, it seems appropriate to discuss the deductibility of some types of plastic surgery. First a disclaimer: we are plastic surgeons, not accountants. Please consult your tax advisor before taking any deductions for plastic surgery based on information provided in this article.

Medical Expenses Tax Deduction

 

According to IRS Publication 502, in order to deduct medical expenses they “must be primarily to alleviate or prevent a physical or mental defect or illness. They do not include expenses that are merely beneficial to
general health, such as vitamins or a vacation.” (On the last point, see our blog on medical tourism). So any money expended to cover a medical insurance deductible is tax deductible.

Plastic Surgery Tax Deduction

 

There are some plastic surgery operations where the individual might not meet insurance company criteria and hence may not be paid for by the patient’s insurance. Chief among these is probably breast reduction surgery for a woman with back pain secondary to large breasts. Insurance companies set their own rules including weight of breast tissue that needs to be removed based on a woman’s height and weight. If
a woman with back, neck, or shoulder pain had to pay for breast reduction surgery out of pocket, she should be able to deduct the cost of the surgery on her tax form.

Now what about cosmetic plastic surgery? According to the IRS “you cannot include in your medical expenses the amount you pay for unnecessary cosmetic surgery”. Examples that Publication 502 frowns upon include “face lifts, hair transplants, hair removal (electrolysis), and liposuction.” However, medical expenses for cosmetic surgery do pass muster with the IRS if “it is necessary to improve a deformity arising from or directly related to, a congenital abnormality, a personal injury resulting from and accident or trauma, or a disfiguring disease.

Then there is the case that has reached epic proportions (pun intended). Cynthia S. Hess, a “self employed professional entertainer and exotic dancer”, known by the stage name, “Chesty Love”, underwent implantation
of custom-made silicone breast implants that increased her bust size to 56N (not a misprint). She attempted to depreciate the cost of her implants on Schedule C of her 1040 as a reasonable and necessary “stage prop”.

The United States Tax Court (Docket No. 11036-92S) in 1994 ruled in favor of Ms. Love stating that “her freakishly large breasts” were “part of her costume.” Whereas clothing, hearing aids, and personal
grooming, even when they help promote one’s business are not depreciable as they benefit the individual, getting 56N size breasts was not done for “the convenience, comfort, or the economy of the individual in pursuing [her] business”. It seems then, that in the eyes of the IRS – you either go big or go home.

In August 2015, a retired fire fighter who had previously undergone multiple facial reconstruction surgeries while at the Elvis Presley Burn Unit of the Regional One Medical Center in Memphis, TN, received a full-face transplant. The plastic surgeons at the NYU Langone Medical Center in New York City performed the most extensive face transplant to date, replacing all skin and facial muscles from scalp to neck on the 41 year-old man who sustained his injuries while in a burning house. 

About two dozen face transplants have been performed worldwide in the decade since the first partial face replacement was performed in France on a woman whose nose and lips were bitten off by her own dog.

A Plastic Surgeon Pioneer in Transplantation

Most people are probably unaware of the leading role plastic surgeons have played in the development of the field of transplantation. In 1954 plastic surgeon Dr. Joseph Murray, performed the first kidney transplant. He transferred a healthy organ from a man whose identical twin was dying from kidney failure. In the days before DNA testing, Dr. Murray compared the brothers’ fingerprints to insure they were identical and would not suffer immune system rejection. 

Murray had become interested in the possibility of transplanting organs while treating burned soldiers during WWII. He noted that cadaver skin, used to replace burned skin, would survive for 8-10 days before it would “melt around the edges”. At the time, the possibility of organ transplantation was deemed impossible so that Murray’s research at Peter Bent Brigham Hospital (now called Brigham and Women’s) was “considered a fringe project”. 

Although the initial transplants were performed in identical twins, Joseph Murray and his team continued their research until they were able to achieve their goal of using “tissue from a dead person to save a human life”. Dr. Murray was awarded the Noble Prize in Physiology and Medicine in 1990 for his pioneering work in organ transplantation.

Where Plastic Surgery and Transplants Overlap

Plastic surgeons along with orthopedic surgeons now perform hand transplants almost routinely so that the Mayo Clinic advertises its hand transplant services on Google. Life saving transplants of kidneys, hearts, lungs, livers, and other organs have become standard practice at many major medical centers. 

New frontiers are opening up with the first uterus transplant performed at the Cleveland Clinic this month and a team of plastic surgeons and urologists at Johns Hopkins preparing for the first penis transplant on a veteran maimed by a bomb.