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.
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.
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.
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.
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.
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?
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.
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.
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.
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.
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.
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.
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.
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 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.