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The popularity of plastic surgery is steadily increasing for many reasons, of which beauty is only one.
By RANDOLPH FILLMORE
© St. Petersburg Times, published November 10, 1999
In 1998, plastic surgeons performed nearly 2.8-million cosmetic surgeries, says the American Society for Aesthetic Plastic Surgery. Overall, there was a 4 percent increase over 1997 figures.
Procedures for women increased 8 percent, while those for men fell by 18 percent (mostly because men were showing less interest in hair transplants). Last year, 90 percent of all cosmetic plastic surgery procedures were performed on women. The year saw big increases in breast augmentation (25 percent), liposuction (23 percent) and cosmetic eye surgery (15 percent). Rather than take their imperfections lying down, it appears younger people, ages 19-34, are getting plastic surgery in record numbers. Gen Xers accounted for 5 percent of the nation's eyelids surgeries, 61 percent of breast augmentations, 42 percent of breast reductions, 52 percent of rhinoplasties (nose reshaping) and 36 percent of liposuctions.
"People are realizing that they have control over not only their general health but that they can do things for their appearance," says Dr. Craig A. Vander Kolk, associate professor of plastic surgery at the Johns Hopkins Medical Institutions in Baltimore. "And this applies to the skin. Preventively, people are spending less time in the sun but also becoming more proactive with skin care, with chemical peels, and laser treatments."
Who should consider cosmetic plastic surgery and when?
"People shouldn't consider cosmetic surgery until their mirror image of themselves is no longer reflective of their self image," says Dr. Michael Coates, a cosmetic and reconstructive plastic surgeon in practice in St Petersburg.
What the ASAPS survey says, in effect, is that younger people are finding their reflective image at odds with their self image. So they are lining up in record numbers for liposuction, breast augmentation and blepharoplasty (eyelid reconstruction).
Ellis sees the reflective image somewhat differently and points again to recent social trends.
"A sociological concept called "the looking glass self' suggests that we see ourselves as we perceive others see us and then make self-judgments based on that perception," says Carolyn Ellis, professor of communication and sociology at the University of South Florida. "Americans are preoccupied with minor physical blemishes that may become stigmas. Minor body stigmas are often interiorized to such a degree that they produce distress and anxiety. The consumer-driven development of cosmetic plastic surgeries demonstrates this. An emphasis is given to overcoming the natural signs of aging."
If you think you are a candidate for liposuction -- a technique where pockets of fat are sucked out of the body by an inserted tube and vacuum -- here's what you need to know:
Liposuction can be used to sculpt hips, buttocks, thighs, knees, and even facial areas. Plastic surgeons insist that the procedure is not a substitute for diet and exercise, but that it can remove fat that is resistant to traditional weight-loss methods. Liposuction is meant to remove an average of 1500 to 3000 ccs (cubic centimeters) of fat. That's about six and a half pounds, says Vander Kolk. It's not for losing weight. To go beyond that is stretching the limits.
"Liposuction is designed to eliminate a disproportionate, localized accumulation of fat that doesn't respond to diet and exercise," Coates says. "It's not a procedure for losing weight. Liposuction has the highest percent of patient satisfaction and the lowest rate of complications of any procedure I do."
Liposuction is performed in an out-patient setting if the amount of fat to be whisked away is not substantial. More than 5,000 cubic centimeters (5 liters) requires a hospital setting since this degree of removal requires a general anesthetic and much of the post-operative risk comes with monitoring larger amounts of fluid loss.
The incisions are small and placed where scars will not show. The surgeon inserts a plastic tube into the area to be vacuumed and carefully sucks out the fat. In a new procedure using ultrasound, sonic energy can be zapped into the fat pockets where the sound explodes the fat cell walls, liquefying the fat for more efficient removal.
Recovery from liposuction tends to be gradual. Swelling, burning pain and numbness are common after the procedure. In older patients, their less elastic skin may be baggy for some time.
Serious complications include blood clots, excessive fluid loss, friction burns to skin and nerve damage. This year we learned that death can also be a complication when several people died. And still, 25 percent more liposuctions were performed.
Plastic surgeons still stress that the procedure is safe and effective.
"Those deaths were not related to the procedure," says Coates. "They were related to fluid mismanagement."
The American Society for Aesthetic Plastic Surgery says that liposuction is safe when performed by a certified plastic surgeon with hospital privileges and when fluid loss is carefully managed during the procedure.
The national average price for liposuctions is slightly more than $2,000.
Eyelid surgery, or blepharoplasty, is growing in popularity for the 19-34 set.
Here's what you need to know: Fat and excess skin and weakening muscle team up to make eyelids droopy and raise puffy bags under eyes. Again, goals and expectations are something a plastic surgeon and patient should discuss and agree on. Talking to a medical insurer might be a good idea, too, as most insurance companies will not cover blepharoplasty unless you can show your vision is being affected.
Eyelid surgery is usually performed with a local anesthetic in an out-patient facility, but can take up to three hours to complete. Your eyelids might feel sore and tight and need ointment and bandaging. If you wear contact lenses forget about wearing them for awhile. Your eyelids will be bruised and your eyes will be gummy for a few weeks. Reading and watching television may be out for a few days as well. The scars may be a little pink for several months, say plastic surgeons.
Like liposuction, breast augmentation should not be taken lightly. If you feel your breasts are too small, if you want to correct a reduction in breast volume after pregnancy, balance a difference in breast size, or reconstruct a breast after surgery, surgeons can insert an implant behind the breast to enhance design and contour.
Generally, ethical surgeons will not make normal size breasts abnormally large.
"If a mature women with a flat chest wants to change her self image and improve her femininity, that's fine," says Coates. "If she is near normal and wants to exceed normal, I pass."
Vander Kolk notes that in the Baltimore-Washington area augmentation has become popular with younger women. Ideally, he says, requests for augmentation should be evaluated individually, no matter what age, and not automatically ruled out.
"If interest in augmentation comes from peer pressure, or family pressure, I think that's wrong," says Vander Kolk.
There is no data to suggest implants interfere with a younger woman's continued development. Two kinds of breast implants are used, a silicon gel or a saltwater solution. Silicon gels have become controversial since leaking silicone implants have been implicated in a number of serious illnesses. The health implications and connections are still under investigation, but silicon gel and saltwater (saline) implants are being used, unrestricted.
Coates is outspoken about the lack of scientific or medical evidence that leaking silicon gel implants ever caused immune diseases or breast cancer.
"It makes about as much sense as saying cataract surgery and a lens implant can cause a duodenal ulcer," says Coates. "There has never been any evidence of direct cause and effect."
Vander Kolk agrees. He says there has never been any clear link between silicon gel implants and systemic diseases.
After general anesthesia, incisions are made in several areas -- where the breast tissue meets the chest, around the nipple, or in the armpit. Working through the incision the surgeon lifts the breast tissue to create a pocket either under the breast or beneath the chest wall muscle and the implants are centered beneath the nipple. Implants placed behind the chest wall muscle will not interfere with mammography.
"Placing the implant under the chest muscle makes a mammogram easier to read and makes a more natural contour," says Coates.
Expect to be tired and sore for a few days. Burning in the nipple area is common and so is the discomfort of wearing a surgical bra for a few days.
Risks include excessive post-surgical bleeding, infection around the implant, and implant breakage or leaking. The saltwater in saline implants can be absorbed by the body, but a leaking gel implant presents a more serious complication. The gel may collect in a part of the breast and scar tissue may form around it. The gel may also migrate to another part of the body. Gel implant leaking or breaking requires more surgery and replacement.
The national average price for breast augmentation is about $3,000.
The American Society for Aesthetic Plastic Surgery suggests that you:
Ask the doctor if he or she is certified by the American Board of Plastic Surgery.
Ask about the doctor's hospital privileges to determine if he or she is affiliated with an accredited hospital.
Ask if the outpatient facility is accredited.
Ask about the doctor's experience, the risks for the surgery, policy on surgical revisions.
Make sure you agree on the final cost.