We live in a society obsessed with youth and beauty. We
greedily tune in to reality shows that take the “average Jane and
Joe” and turn them into super-model material with the help of
cosmetic procedures. We watch in morbid fascination as a certain
celebrity’s nose seems to disappear while another’s lips
threaten to explode.
Even more astounding is the fact that we openly admit to
having the occasional nip and tuck ourselves and discuss various
procedures over coffee as easily as if we were discussing
what to cook for dinner. It’s a multibillion-dollar industry and
one that shows no signs of slowing down. According to a study
done by the American Society of Plastic Surgeons, Americans
spent more than $1 billion on breast augmentation and more
than $2 billion on Botox injections in 2006.
Are we in danger of going too far? According to Dr. Howard
T. Wang, assistant professor and program director of the plastic
surgery residency program at the University of Texas Health Science
Center, not if we understand the risks and benefits and
keep our expectations realistic. “When done properly by a
trained professional, cosmetic surgery is a safe product that delivers
what the public wants,” he says.
The ideal candidate
If you are considering cosmetic surgery in the hopes that it will
completely transform your life, you might want to reconsider. “You
have to understand the limitations and what plastic surgery can
and cannot do,” explains. Dr. Wang. “Making your breasts larger
isn’t going to make you keep your boyfriend.”
Board-certified plastic surgeons are trained in how to screen patients
and identify those that have unrealistic expectations. They
then work to educate those patients on what to expect, or they
might discourage the patient from having the procedure. In some
cases the surgeon might even refuse to perform the surgery if he
deems the patient to be high-risk, psychologically speaking.“It is a well-known fact that there are patients that have killed
their plastic surgeons,” Dr. Wang points out.
And then there is the fact that your body will not look the same.
Some people might consider that a good thing, but realistically
it can take some getting used to. Consider Jennifer Grey, the actress
best known for the film Dirty Dancing, who underwent
rhinoplasty to alter her rather large nose. The result was that she
was almost unrecognizable.
Another common problem is women who want excessively large
breasts. Dr. Wang explains that the implants are very heavy and
cause the breast tissue to thin out. If the patient eventually wants
to remove them and put in smaller implants, the risk of deformity
is greater because of the extra sagging skin.
So what is a good reason for cosmetic enhancement? The best and
most common one is improved confidence and self-esteem, and according
to Dr. Wang, that one is pretty realistic. “People want to look
good in their clothes when they are walking down the street,” he says.
Knowing your options
Cosmetic enhancement consists of two categories: invasive and
noninvasive procedures. As the name suggests, invasive is anything
surgical. According to the American Society of Plastic Surgeons,
the top five cosmetic surgical procedures are breast
augmentation, rhinoplasty, liposuction, eyelid surgery and tummy
tucks.
Of the non- or minimally invasive procedures, Botox®
leads the way, followed by chemical peels, laser hair removal,
microdermabrasion and fillers such as Restylane®. Before undergoing
any of these procedures, you should do a little research
and know your facts.
Breast augmentation
Breast augmentation can be performed in several different ways
in order to minimize scarring. One of the most common is to cut
very closely around the border of the areola with the idea that when
the scar heals, it will blend in with the darker skin. Another popular
option is to make the incision at the base of the breast, again
minimizing visibility. Other, trickier options include going under the
armpit and avoiding the breast completely and the endoscopic
method, where the surgeon performs the entire procedure through
the belly button.
Regardless of the method you choose, the result should be
firm, natural-looking breasts. These can be achieved through either
saline or silicone (which has been FDA approved again) implants.
As for the size, Dr. Wang encourages his patients to
experiment with placing implants in their bras until they achieve
the size they want — usually a C cup. “Ninety percent of women
who come in for either augmentation or breast reduction want a
C cup,” he says.
And while Dr. Wang says it is mostly younger women who come
in for implants, he does suggest waiting until you have completed
your family before going under the knife. “Any weight gain, including
pregnancy, can change the shape of the breast,” he cautions. “And there is a slight chance that you might not be able to breastfeed
effectively.”
Then there is the fact that the older you are, the less likely it is
that you might have to come back in for “tweaking,” as many implants
can last for 20 years or more.
Rhinoplasty
According to Dr. Wang, rhinoplasty is the most revered of all
plastic surgeries: “It is the one surgery that is the hardest to get
right, and if it goes wrong, it can be devastating both physically
and functionally.” The good news is that insurance often covers rhinoplasty since
it is usually performed as the result of a broken nose or a deviated
septum, both of which can make breathing difficult.
Liposuction
To put it bluntly, liposuction is the process of vacuuming out
fat from the thighs, stomach or buttocks. As Dr. Wang explains,
there are two purposes for liposuction: complete reshaping and
body contouring.
Complete reshaping is controversial because of the fact that removing
several liters of fat is an assault on the body, not to mention
the amount of Laticain needed that, in large doses, can be
toxic or fatal. There is also the chance that the skin might not return
to normal after the fat is removed, and additional surgery will
be needed to remove the excess.
Body contouring offers better results and is ideal for those people
who exercise and eat properly, yet still carry a few extra inches
around their thighs.
Eyelid surgery
The eyelid lift is used to correct visibility field blockage when the
skin on the eyelids begins to sag to a point where vision is impaired.
Occasionally a heavy brow is the culprit, and a brow lift
might be necessary as well. If your vision is impaired, there is a
good chance that your insurance will cover the procedures.
Tummy tuck
If breast augmentation is for the younger crowd, then the tummy
tuck is for those women who are usually finished with having children
and ready to deal with the aftereffects. “During pregnancy the
muscles are stretched out, and the skin doesn’t shrink back,” explains
Dr. Wang. Removing the extra sagging skin can provide contour
and definition again.
Botox®
Injecting Botox into the skin on the forehead and around the eye
area paralyzes the muscles. The result is that they are unable to
contract and therefore unable to form wrinkles. Don’t think of it,
however, as an alternative to a face lift.
“People think of face lifts as wrinkle reducers,” says Dr. Wang.“The truth is that they are more of a rejuvenation. Age causes the
skin to sag and lose elasticity, resulting in the ‘jowling’ effect, and
no amount of Botox® can help with that.”
Chemical peels
Unlike the over-the-counter peels, a professional chemical peel
uses a strong chemical solution to smooth the texture of the face
by removing the damaged outer layers. It is wonderful for people
with sun damage, age spots and fine lines and wrinkles. Like most noninvasive procedures, it does not offer the same results as a face
lift, but it works well in conjunction with that procedure.
Laser hair removal
Laser hair removal is the process of permanently removing the
hair through a series of laser treatments that kill the hair follicle. Depending
on the coarseness of the hair, it can take several treatments,
but the hair will become sparser as the treatments progress.
The laser picks up on the contrast in pigmentation between the
hair and the skin, so it is not as effective for those individuals with
dark skin or with very light hair.
Microdermabrasion
Microdermabrasion uses tiny crystals to abrade the skin and remove
the top layer with minimal redness. Like the chemical peel,
it is effective in reducing fine lines and wrinkles and evening out the
complexion, but without the harsh chemicals.
Restylane® and other fillers
Fillers are injectables that are used to fill in deep lines, such as
those that run from the nose to the mouth (nasal-labial folds) and
the lines from the mouth to the chin (marionette lines). It is often
used in conjunction with a face lift since a face lift doesn’t address
the problem of nasal-labial folds very well.
Know your risks
Just as it is important to understand what the procedures can and
cannot do, it is equally important to understand the risks involved.
Recently the death of a rap singer’s mother from complications
following liposuction made the headlines. “It’s rare, but people can
die after a plastic surgery procedure,” says Dr. Wang. “It is real surgery
and not a weekend spa package,” he adds.
Risks can include reactions to medications and anesthesia, or,
in the case of liposuction, there is the risk that a blood clot can develop
in the leg and move to the lungs or heart.
“Patients must be screened very carefully for significant risk factors,”
advises Dr. Wang. Those risk factors include smoking, diabetes
and heart disease, to name a few. “I personally will accept
almost no risk if you are coming in for an elective procedure that
you don’t have to have,” says Dr. Wang.
Sadly though, there are some doctors that will. One of the best
things you can do to lessen any risk of complication is to find the
best surgeon — but that can also be one of the hardest. Dr. Wang
explains that in order to legally perform surgery you simply have to
have a license in the state. What that means is that anyone who is
licensed in the state of Texas can perform any type of surgery without
extensive training in that field.
“You can just take a weekend course,” explains Dr. Wang. “Technically,
I can deliver a baby, but that’s probably not too smart.”
So where do you begin to find the surgeon that meets your
needs? First try word-of-mouth. People are really eager to share
their cosmetic surgery successes and will usually be more than
happy to recommend a surgeon.
When you are interviewing surgeons, ask them how often they
have performed the procedure you are requesting and how comfortable
they are with it. Ask for references and even photographs.
Bear in mind, however, that no surgeon is going to show
you a bad photograph. “The photos are always of the best results,” cautions Dr. Wang. “Anyone can hit a home run once in
a while.”
Look at where the surgeon operates. It should be in an accredited
facility with the appropriate emergency equipment on hand.
A safe bet is to look for a board-certified surgeon. Certification
doesn’t guarantee surgeons’ work, but it does guarantee that they
take their work seriously enough to go through the training and
tests required to become certified and that the American Board of
Plastic Surgery deems them safe.
The bottom line
Cost is an important factor in cosmetic surgery, and it is wise to
be leery of those who offer to do procedures for hundreds of dollars
less than the norm. What should you expect to pay? Ballpark
figures, according to the American Society of Plastic Surgeons, are
roughly $2,800 for liposuction up to approximately $5,000 for a
tummy tuck. For noninvasive procedures, you are looking at somewhere
between $500 and $1,000 for injectables, while laser hair
removal, peels and microdermabrasion fall into the $200 to $600
category.
Is it too much to spend in the quest for youth and beauty? That’s
a personal decision. But as Dr. Wang points out, most of us spend
just as much money on our hair, cosmetics, clothing and spa treatments,
and there is no social stigma to it anymore.
“The explosion of plastic surgery around the country has given it
legitimacy and made it socially acceptable,” he says. “If it truly
makes someone feel better about themselves and the way they
look, and they have the money, then why not?”
