Introduction to Cosmetic Surgery
The word plastic comes from the Greek word "plastikos", which means to mold or
give form. Plastic surgery enables us to model or re-form the human body. The
plastic surgery specialty encompasses both reconstructive surgery and
aesthetic surgery, popularly referred to as cosmetic surgery. Reconstructive
surgery restores or improves physical function and minimizes disfigurement from
accidents, disease or birth defects. While not essential to physical health,
aesthetic surgery can make a significant contribution to the quality of life by
improving the appearance of normal body features and enhancing self-image.
Federal Trade Commission
Statistics show that each year, an increasing number of Americans elect
aesthetic surgery to change the way they look. Some have noticeable changes
made; others, subtle refinements. Once considered the exclusive domain of
women, aesthetic surgery now is in demand by men who recognize the results
and benefits it can bring. Regardless of an individual's gender, the decision to
aesthetic surgery usually is based on personal factors as well as on the
accepted values of our society.
Are you a Good Candidate for Cosmetic Surgery?
The ideal candidate for aesthetic surgery is an individual who recognizes a
specific area in which his or her appearance could be improved and has a strong
personal desire to make a change. This personal desire may be influenced to
some degree by the individual's role in society. Because our culture is
youth-oriented, people seek ways to counter the effects of aging on their
appearance. Many elect surgery to look as young as they feel, to build
confidence after a lifestyle change or to retain their edge against younger
competitors.
Whatever your reasons for choosing aesthetic surgery, it is important to have
realistic expectations. Improving a feature of the face or body may give you
greater self-confidence and add to your sense of well-being, but it is not a
guarantee of happiness or better relationships with others. Surgery can enhance
your appearance; the rest is up to you.
As with all surgical procedures, cosmetic
surgery carries with it certain risks.
Select a doctor who is well-trained and
experienced in performing the specific procedure
you want. (For help, use the questions listed
inside.)
Find out beforehand any possible side effects,
risks, and complications of the surgery you want.
Early on, discuss with your doctor what goals
you hope to accomplish with cosmetic surgery
and whether these goals are realistic.
Remember that insurance usually does not cover
costs for elective cosmetic surgery.
Minimizing the Effects of Aging
Nowhere does aging leave its imprint more noticeably than on the face. Sun
exposure as well as aging contribute to facial wrinkling, as do diet, the amount
of alcohol you consume, and whether or not you smoke.
Facial rejuvenation surgery may involve procedures of the face and neck,
eyelids, forehead and eyebrow areas, and procedures to reduce fine skin lines.
These procedures can often be performed at the same time or can be carried
out in separate sessions.
Which procedure, or combination of procedures, is right for you depends on
your personal objectives and the opinion of your surgeon.
Redefining Facial Features
Irregularities of the nose, ears, cheeks or chin may upset the balance of the
face and affect the overall appearance, since these features are often viewed in
relation to one another.
Aesthetic surgery can reshape the nose, diminish prominence of the ears, and
reshape the chin or cheeks to improve excesses or deficiencies in these areas.
In many cases, changing a single facial feature can enhance your entire
appearance and affect the way you feel about yourself.
Body Contouring
There are several aesthetic procedures to reshape the breasts, abdomen and
other parts of the body. Dramatic advances have been made in recent years,
particularly in suction techniques that now often replace more extensive surgery
to remove unwanted fat.
The success of body contouring - whether it is done to reduce, enlarge or lift -
is influenced by your age and the size, shape and skin tone of the area to be
treated. While some contouring procedures leave small scars, more noticeable
scars may result when surgical removal of fat and skin is necessary to achieve
desired results. In such cases, you must be willing to accept these scars in
exchange for looking better in clothing.
These questions are designed to help you decide if your expectations about
cosmetic surgery are realistic and if surgery is the right choice for you.
The overriding question you must answer is: Is this operation, at this time
in your life, to your advantage emotionally and physically?
To answer this fundamental question, you should know where you stand on
these specific issues:
Why do you want this operation, at this time in your life?
What do you expect it will do for you physically? Emotionally? Socially?
What are your expectations that you tell others about?
What are your "hidden expectations" - the reasons you don’t want people
to know about?
Is your concern about your cosmetic problem out of proportion to what
others think about it?
Do you expect the operation to improve your relationships at work?
Do you think it will alter a personal relationship you have with someone
now?
Do you think it will make it easier to form new relationships?
If you are in psychotherapy, have you discussed having plastic surgery
with your therapist?
Are looks really that important?
Yes, and no. Most people would agree that what is on the inside of a person is
more important than what's on the outside. But we are beginning to understand
that what is on the outside is pretty important too. How you look can have a
direct impact on how you feel about yourself. If there's something that you don't
like about the way you look, it can make you feel self-conscious, lack confidence,
and unhappy.
That's the real story behind today's cosmetic surgery. It's not about vain,
self-indulgent, narcissistic people. Not at all. It's about ordinary people with
problems. Whether it's a nose that's too big, breasts that are too small, or
wrinkled sagging skin that makes someone who feels young and alive, look old
and depressed. It could be a problem that you were born with, or one that
comes with age. Whatever the cause, it's a problem. It's not necessarily a
problem with the way it makes you look - but because of the way it makes you
feel.
Cosmetic surgery can help ordinary people solve problems that make them
unhappy, procedures that can help you not only look better but feel better as
well. They can often lead to improved self-esteem and increased self-confidence.
Think of it as a little change on the outside that can lead to a big change on the
inside. That's what cosmetic surgery is really all about. Big changes... on the
inside.
Everybody has seen bad plastic surgery. You can spot it from across the
room. Tight, plastic, unnatural results that detract from someone's looks rather
than enhancing them. Nobody wants to look like that. Nobody wants to look like
they've had plastic surgery.
The best surgeon in the world can't help you if your motivation is wrong, or if
your expectations are unrealistic. Most importantly, you should be doing it for
yourself. Not for your spouse, your children, your friends or anyone else.
Secondly, you should be doing it for the right reasons. Cosmetic surgery
cannot save a bad marriage. It won't turn you into a movie star, and it won't turn
an unhappy life into a happy one. But there's a lot it can do.
It can improve your looks. It can help you look as young as you feel. And
sometimes it can even boost your self-esteem and self-confidence. The rest is
up to you. You should be realistic about what you'll look like afterwards.
Cosmetic surgery deals in improvement - not in perfection. If you can accept
that, your surgery will be successful. If your expectations are realistic and you're
doing it for the right reasons, the chances are excellent that you will be happy
with your results.
What You Should Know Before Electing Surgery
Fees and insurance. Fees for aesthetic surgery traditionally are paid prior to
surgery. Costs vary widely and depend upon the complexity of the operation,
where the surgery takes place and which anesthetic is administered.
As a rule, aesthetic plastic surgery is considered "elective surgery" and is not
covered by most insurance plans. However, sometimes there is a fine line
between whether the surgery’s prime objective is to improve appearance or to
improve function. For example, protruding or large ears may be considered a
birth defect and ear surgery deemed necessary to correct it. Similar judgments
may be made regarding eye surgery if drooping lids impair vision, or breast
reduction if the weight of the breasts causes pain or interferes with normal
activity. If this is the case, contact your insurance company before surgery to
determine how it views your particular surgery.
Aesthetic surgery may be tax deductible in the same way as other medical
expenses. Consult your personal tax advisor.
Surgical Facilities and Anesthesia.
Surgery can be performed in a number of
locations, depending upon the procedure and what your surgeon regards as
appropriate. Generally, aesthetic surgery takes place in a hospital or an
ambulatory care setting - such as an outpatient center or your surgeon’s
office-based surgical facility.
In many cases, a local anesthetic will be administered to numb the area to be
treated, along with a sedative to relax you. For some aesthetic surgical
procedures, however, you’ll be given general anesthesia so you’ll sleep through
the entire operation. Postoperative pain is normally controlled with medication.
Risks and complications. Although some of the procedures described
appear to be relatively simple operations, it is essential for you to understand
that aesthetic surgery, like all surgery, has attendant risks.
Plastic surgeons perform thousands of successful aesthetic procedures each
week, but in some cases a patient can have an adverse reaction to the
anesthetic or be affected by postoperative complications such as blood clots,
infection or poor healing. These problems can occur even when the surgeon has
performed the operation with the utmost skill. Since smoking may interfere with
proper healing and aspirin may increase the risk of excessive bleeding, you may
be advised to avoid them before and after surgery. Occasionally, surgical
revisions may be desirable to achieve optimal results.
It is important to remember that aesthetic surgery molds and reshapes living
tissue, and the results are not absolutely predictable. Even the best surgeon
cannot offer risk-free surgery nor guarantee a perfect result.
Recovering from your surgery. Your surgeon will inform you of any
restrictions to your normal activities following surgery. In general, you should
curtail strenuous exercise and other activities that raise your blood pressure,
including bending, for several days to weeks (depending on what type of surgery
was performed). It takes time as well for the visible signs of healing to subside.
Do not expect to see the final results of your surgery right away. Plan your
social activities to allow sufficient time for recovery.
Other considerations. The results achieved in some aesthetic procedures,
such as surgery of the nose, ears and chin, are permanent. In others,
particularly those that diminish the effects of aging, results may be long-lasting
but not permanent. Your aesthetic plastic surgeon may be able to turn back the
clock but cannot stop it from running.
Are You Well Suited for Cosmetic Surgery?
Over the years, surgeons and psychologists have found that certain attitudes
indicate that cosmetic surgery is appropriate for a patient.
Is There a Real Flaw or Imperfection?
First, is there really a cosmetic flaw that lends itself to surgical correction? Do
you have a large nasal hump or a bulbous tip? Is your face sagging? Does you
chin appear flawed or unharmonious with the rest of your face? Does this flaw
lend itself to improvement?
Are You Motivated for Yourself?
You are better suited for cosmetic facial surgery if you wish to please yourself,
not your family or friends. Can you honestly say to yourself, "I want this
operation even if no one but me ever notices anything about me has changed?"
If so, then you are a good candidate for surgery.
Are Your Goals Well Defined?
The person who, upon entering the surgeon’s consultation room, asks a
vague, lack of focus question such as "What can you do to make me look better? I
haven’t liked the way I look for years," is not a good candidate for cosmetic
surgery. This person has no clear goal.
Anesthesia
Whichever cosmetic surgical procedure you have done, it will require
anesthesia. It is important to know as much as possible about anesthesia, so
that you feel confident your surgery will be painless and anxiety-free.
Most People have heard the terms "local" and "general" anesthesia. Will
general anesthesia the patient is put to sleep. This anesthesia is usually
associated with "serious" operations. Many people have experienced local
anesthesia in the dentist’s chair. Here, a specific area of the body is numbed by
the local injection of medication at the site where the surgery will be performed.
Today, with the great advances in anesthesia, an entire spectrum exists
between local and general anesthesia to eliminate pain and minimize anxiety.
Here’s how it works.
Before the operation either a nurse-anesthetist, working under the direction of
a surgeon, or an anesthesiologist visits the patient. This medical specialist
should take sufficient time to meet the patient and evaluate the patient’s
concerns or anxieties about the operation and anesthesia. Then a thin
intravenous catheter is inserted into a vein in the arm. This open pipeline is
imperative during any surgery. Should the patient require additional medication
for any reason, such medication can be given quickly and safely through the
catheter.
Before placement of the catheter, a sedative or tranquilizer(Valium, for
example), may be given orally. This induces a pleasant state of drowsiness.
Additional sedation may be given by mouth or through the intravenous catheter.
This allows the local anesthesia (given in the operating room) to be injected
without any unpleasant sensations.
The local anesthesia is then injected into the area where the operation will
take place, along with a small amount of adrenaline, which causes the blood
vessels of the area to constrict. This helps to minimize bleeding, while the
anesthetic "blocks" or "freezes" the tissues so no pain is felt.
The drowsiness induced by the intravenous sedative may become a twilight
sleep. Some patients experience a sense of well-being bordering on euphoria.
Others may feel completely unconscious, even though, medically speaking,
they are only lightly anesthetized. They can respond to commands and even
answer questions. When performing cosmetic surgery on the face, most
surgeons prefer this state to total unconsciousness because the operation is
done on a face that is not completely relaxed.(The muscles of a deeply
anesthetized face are so relaxed that they lose their usual tone.) The patients
wakefulness also allows the surgeon to give commands (look up; look down;
open your mouth; show me your teeth, raise your eyebrows), and the amount of
excess tissue to be removed is more easily estimated.
Another advantage of sedation is that medications may be used to block out
all memory of the operation. The patient recalls either a pleasant twilight state or
remembers nothing. The patient is comfortably relaxed during the operation.
Breathing, heartbeat, and other vital functions remain strong and steady the
entire time.
Some patients prefer being put to sleep. They want their surgery in a state of
complete oblivion, wishing to wake up without any memory of the operation.
Others prefer being fully aware of everything in the operating room.
They want to retain a sense of control over mind and body, wishing to recall
the surgery clearly and completely. These patients may request minimal
sedation - enough for relaxation - but not enough to cause drowsiness.
As many people know from visits to the dentist, a pain-free procedure does not
guarantee that there will be no anxiety. Some find lying or sitting back (in a
dental chair in an operating room) very trying, even though it is painless. There
is no need to endure anxiety during an operation! It is important to know that the
combination of anesthetics can alleviate this. By regulating the amount of
sedative given, the patient can be made to feel comfortably anxiety-free while
surgery proceeds painlessly.
Another option may be medical hypnosis for pain and anxiety control. This is
not at present a popular method of anesthesia, but evidence is accumulating to
indicate that hypnosis may become more widely used for cosmetic surgery in
the future.
Possible After Effects of Anesthesia
There may be some after effects of anesthesia. Some people have a slight
feeling of nausea during the immediate postoperative period. This will pass
quickly. Some people may vomit, but this is infrequent. Some patients may feel
slightly lethargic for the first few hours after surgery. This will wear off.
These possible consequences of anesthesia are not necessarily dose-related.
Rather, they depend on how much you individually react to the anesthesia.
Some people may have after effects even with slight amounts of sedation. These
minor problems make it mandatory that you be observed during the immediate
post-operative period. A trained nursing staff must be available, and should you
experience any unpleasant feelings after surgery, do not hesitate to call on
these professionals.
We have outlined the basics you need to know about anesthesia for cosmetic
facial surgery. Most important to remember is that anesthesia is an integral part
of your surgical experience. You should know as much about it as possible. Not
knowing enough invites feelings of helplessness and anxiety. These unpleasant
feelings are needless. You should thoroughly discuss anesthesia with your
surgeon before you enter the hospital or clinic for your cosmetic surgery.
What Causes Wrinkles and Sagging?
With age, various changes occur in facial skin. Connective fibers located
within the skin layers allow the skin to stretch and then return to its original
shape. Over the years, these connective fibers decrease and they function less
efficiently. The skin cannot easily return to its former position after it is
stretched. We all know that a young person who loses 40 pounds may end up
with tight skin, while an older person having lost the same weight will then have
loose, hanging skin.
With time, these skin changes result in a downcast look of the face, as the
skin, the muscles, and the fat beneath it begin to droop. The aging face has
specific areas that are most likely to be affected by this process. These include
the drooping of the brows, the down turning of the nose, the down turned corners
of the mouth, the heaviness of the jowls, causing the loss of a sharply contoured
jaw, the drooping and deepening of the folds running from the nose to the
corners of the mouth to the jaw. This facial drooping is the result of on-going
changes in the skin, fat and muscles of the face.
When should I have a Face Lift?
Most people requesting surgical face lifts are between the ages of 45 and 60,
although there are both younger and older patients. About three-quarters of
patients are women, and most are honest about their reasons for desiring
surgery. "I just don’t like looking older." Some patients ask the surgeon to "take
a few years off my face." To many people, a distressing feature of the aging face
is the sagging crepe-like neck. "It makes me look so old!", many patients
complain. Many people hope that an operation to rejuvenate their appearance
will make them look as young as they feel. As a matter of fact, many people
requesting face-lifts say, "Doctor, I’m tired of looking older than I feel!". They
often feel that on the inside they are young and vital, but that somehow their
appearances are betraying them.
When to have a face-lift is an important question; so is the issue of when not
to have surgery. We occasionally see a patient who requests face-lift surgery
when there are only minimal signs of aging. While such cases are rare, they do
occur. Some people may exaggerate the first signs of aging. Fearful of getting
older, they view the most minor facial crease or change in skin tone with undue
alarm.
In another group of patients, the request for face-lift surgery is coupled with
important psychological concerns. Occasionally, men request surgery, fearing
they will no longer be able to compete with younger men at the office. This must
always be evaluated carefully. There are situations where a youthful appearance
is vital for job advancement or to maintain one’s position. Many men, not
necessarily fearful of aging, are afraid of losing their jobs to aggressive, younger
men. For them (and for many people), self-esteem is tied to their work lives.
They must work in order to feel worthwhile, and they need to feel they are
successful at their work. These are normal, commonly encountered feelings.
Such people may be good candidates for face-lift surgery, provided they are not
looking for something unrealistic in the surgery.
Occasionally, a patient will have unrealistic expectations about face-lift
surgery. A patient may harbor the incorrect notion that a face-lift will not only
erase years from his face, but will also turn him into a young dynamo.
Unrealistic expectations about the results of facial rejuvenation can only lead to
disappointment. A complete consultation will resolve such misunderstandings.
Before you sign the consent form and set a date for surgery, can you
answer YES to the following questions?
Do you have a clear idea of the results you can expect?
Are you clear about the result the doctor expects?
Are these two pictures the same? (Do you and your doctor agree on the surgical
objectives?)
Do you know the incidence of complications for your procedure?
Do you know what kind of scars you can expect?
Have you chosen a good time to schedule surgery, with adequate time for recovery?
Smoking Retards the Healing Process
So Don't Smoke
Smoking interferes with healing after surgery, particularly in the cases of
breast reduction, facelift, "tummy tuck," and other procedures that involve the
creation of skin "flaps."
Smoking constricts blood vessels and decreases blood flow all over the body.
Even more important, the carbon monoxide in cigarette smoke greatly reduces
the blood’s ability to carry oxygen, which is essential for wound healing.
Smoking slows healing, and if a skin "flap" was used, the wound may not heal
at all.
In a landmark study conducted by New York University’s Institute of
Reconstructive Plastic Surgery, cigarette smoking figured as the major cause
of serious wound-healing complications in a significant percentage of the 1,186
facelift patients who participated. If you smoke cigarettes and inhale, you are at
least 12 times more likely than nonsmokers to heal poorly after a facelift.
Translated, this means a prolonged healing period and consequent delay in
returning to your job and social activities. Worse, the final results of the
operation can be marred by unsightly scars.
If you have general anesthesia and also smoke, you may develop a hard
cough that can cause internal bleeding. For all of these reasons, smoking is
against the rules for cosmetic surgery patients.
If you cannot give up smoking for one to two weeks before and after the
operation, your surgeon may want you to rethink your decision to have plastic
surgery. People choose to have plastic surgery to improve their looks and sense
of well-being, so it makes little sense to jeopardize the results by failing to
forego smoking for several weeks. If you are a smoker trying to quit, this may be
an excellent opportunity to give up the habit altogether.