Should You Restrict a Procedure?

Recently, another TikTok sensation (over 323,000 views) hit the internet when Zoe Grace Tong, a nanny in Auckland, New Zealand, went viral with a post about her challenges after receiving the “Fox eye” thread procedure (https://www.tiktok.com/@zoeetong/video/7116844636651523330). Those challenges included the loss of $650, a black eye, swelling, bleeding, incomplete procedure, and lack of results.

The fact that it was done at a “salon” by a nurse (possibly) may have had everything to do with the ultimate result. However, in this age in which we can be assured that each product and procedure that is developed will eventually (perhaps quickly) fall into the hands of the “lowest-common denominator” of practitioners, it seems incumbent to limit certain procedures or, at the very least, develop them with an understanding that they will be in inexpert hands before too long.

It amazes me that procedures that I personally feel uncomfortable doing due to the risks and possibilities of protracted and eventful recovery processes–from threadlifts to “liquid” rhinoplasties and eventually tissue microcoring devices–are done flippantly by nurses in med spas and spas with very little, if any, medical supervision. This may be simply an example of not knowing limits and blissful ignorance, but again, this is the milieu that we find ourselves in and perhaps if we can’t control who does procedures, we should police with our voices and purchases which procedures ought to be available.

To me, thread lifts are a sad, but perfect example of this. While I have occasionally seen good results from them (although I don’t do them), I have more often seen only problems, ranging from extruding threads, lack of activity, asymmetry, and nerve damage. Is this what we want the public to see when they think of cosmetic surgery? I have wanted to like this procedure, being ostensibly “trained” in it twice, first in 2007 and then again in 2016. Both times, I took a hard pass when I realized they were simply not ready for prime time.

My rationale for which procedures ought to be “canceled” comes down to the likelihood of success for a procedure, when performed by an “average” or “less than average” practitioner and the risk of complications. Additionally, it encompasses the types of complications. While a heroic oncology surgery may result in a miniscule likelihood of success, the odds are there to go forward. On the other hand, a cosmetic procedure should have a preponderance of reward and a very small amount of risk, especially when it is placed on the open market with untrained and unqualified people administering it.

Perhaps my mind is focusing on the risk-reward ratio more because of the recent submersible disaster. The group of operators and safety organizations in this industry knew that OceanGate was performing an extremely risky maneuver but lacked the courage or ability to stop these poor souls from going to their deaths. On the other hand, courage isn’t something we lack as cosmetic dermatologists. We owe it to the public to call out a bad procedure, such as threadlifting, when we see one. It won’t do us or our patients any good if we don’t. Additionally, if we see procedures that, when performed by (and encouraged to be performed by) suboptimal practitioners result in harm to patients, we owe it to our profession and our patients to call it out. Societies ranging from AAD to ASDS and many others have been working diligently to sound alarms, but companies easily sidestep the issue by pointing out rules that require them to sell to any given provider. It’s time to think differently.

We can’t police every procedure out there and not all of our procedures will result in significant adverse events (or lack of results) when performed incorrectly or in the wrong environment, but when we see these, we need to speak up for the good of the many. I don’t know whether this can impact the discussion, but hopefully, those of you who are considering doing this procedure will think it over before lumping yourself in with the charlatans that are now doing it and causing harm. Perhaps, once the companies that sell these technologies see that the medical community is hanging back and understanding the damage they have perpetrated, they will reconsider selling to anyone with a pulse.