Plastic surgery: no longer just for the rich and vain. THROUGHOUT the centuries, plastic surgery intimately has been involved in the re-creation of missing body parts, reanimation of paralyzed faces, and the restoration of the function of hands. It encompasses the creation, maintenance, and rejuvenation of self-esteem. Plastic surgery comes from the Greek word plastikos, which means to fit for molding. Its origin can be traced to India, approximately 600 B.C., with the practitioner Sushruta, who reconstructed criminals' and captured prisoners' noses and earlobes that had been amputated.
The cornerstone of modern plastic surgery was laid by Gaspare Tagliacozzi in the late 1500s. His reconstructive works were known throughout Europe, and people traveled from all over to Bologna to receive his assistance.
Wars always have offered the greatest training fields for the plastic surgeon, beginning with the Napoleonic Wars. In each succeeding conflict, major breakthroughs were made in technique in the treatment of burns, facial injuries, and reconstruction, as well as prosthetic devices that offered some sort of normality, allowing injured warriors the opportunity to reclaim a form of self-esteem and dignity.
Plastic surgery as a specialty involves not only the cosmetic portion of surgery, but also the reconstruction and treatment of head and neck cancers, burns, and severe hand injury; transfer of tissue to
cover defects; and the re-animation of portions of the face and extremities that lack normal movement due to trauma or paralysis.
Once thought to be only accessible to the very rich, it now is available to people in all walks of life, from the business executive who must maintain his appearance in order to hold on to a high-pressure job to the secretary who must extend her working life into her 60s and 70s. A youth orientation dominates the job market, with the best positions available to those who look the fittest, healthiest, and most youthful. Men have realized that they, too, are entitled to look their best. During the past 20 years, the percentage of male patients seen in the plastic surgeon's office has grown from one to approximately 40.
Within the area of plastic and reconstructive surgery, four basic indications call for these procedures: genetic malformation, changes induced by childbirth, damage caused by physical trauma, and changes created by aging and excessive sun exposure.
Starting at the top of the body, the lack of hair or a chin, a prominent nose, and recessive cheekbones would fall under chance genetic malformations that can be corrected surgically. A lack of hair may be helped by the use of rotation of scalp flaps, lessening of the bald area with scalp reductions, and/or hair transplants. The nose is treated by reducing size or altering its shape. The chin can be improved by adding an implant or moving the chin forward.
The changes caused by aging and exposure to sun--looseness and wrinkling of skin around the neck and jowl areas--can be tightened with a facelift. Bagginess and fullness beneath the eyes and excessive skin above them are improved by removal of the bags and tightening of the skin. Elevation of the eyebrows and smoothing of the lines of the forehead can be accomplished by a forehead lift. The texture of the skin--fine wrinkling and color irregularities--can be smoothed and softened with the use of sanding (dermabrasion) or chemical peel. These procedures, when performed by a well-trained, qualified surgeon, should be relatively pain-free and safe.
The trunk of the body can be transformed as well. In the chest area, breasts are present in the adolescent male. Frequently, residual breast tissue remains as he grows older. This can be treated by liposuction or removing the congenital breast tissue by making a tiny incision at the nipple areola.
In women, pregnancy frequently leaves the breasts empty and flattened. Some women have progressive enlargement of their breasts following childbirth. This condition is helped by reduction of breast size. Those who have lost their breast tissue can be treated by enlargement or augmentation, and women with drooping breasts can have the tissue elevated without using an implant.
In middle-aged men, the stomach and flank areas offer difficulties. It is harder to get rid of the pouching that occurs in the abdomen, as
well as "love handles" on the flanks. In women who have had children, muscle tone may be lost in the abdomen, and the skin tends to hang. Liposuction is available to suction the fat tissue that lies in males' lower abdomen, removing the love handles and giving the body a more youthful appearance. In women, the abdomen can be tightened, muscles can be returned to their normal position, and the stomach once again can be flattened so that a two-piece bathing suit can be worn.
In the body's extremities, irregular fat distribution or excessive skin secondary to the loss of fat in the arms or thighs can be treated by surgically removing it. For excessive fat in the area of hips, knees, thighs, and arms, liposuction also has been utilized with excellent success.
To whom would such improvements in appearance be useful? Examples include the lawyer who must present himself or herself regularly to a jury or judge and whose appearance weighs heavily on the way he or she is perceived; the salesman who meets people face-to-face when presenting his wares for consumption, selling himself as well as the product; and all those who deal with the public on a regular basis, whether an accountant in Iowa, contractor in Mississippi, secretary in New Mexico, or hairstylist in Washington. I often am amused by those who are reticent to spend the money to improve their appearance, but think nothing of replacing their automobile or wardrobe on a regular basis.
A word of warning
When considering self-improvement via the use of aesthetic surgery, carefully consider two important parameters: those of personal expectations and the qualifications of the individual chosen to perform the surgery. It must be understood that miracles can not be achieved,
expectations from the surgery must be realistic ones, and the surgery itself will not change the life of the patient--only his or her appearance is altered. One also must be aware that, as with all surgical procedures, complications can arise. The doctor must discuss these possibilities with the patient carefully. The media have led people to believe that cosmetic surgery is innocuous, there are no complications, and one has the operation and returns to work the next day. This is misleading and people should beware of any statements that imply or promise these results.
Also be careful when selecting the physician to do the surgery. Be sure that he or she is trained and capable of performing the operation, since, in the U.S., any doctor who graduates from medical school is legally permitted to perform plastic surgery. In California, as with most other states, unqualified physicians can be found doing all forms of surgical prcedures, usually in an office setting where they are unmonitored and unsupervised. Therefore, it behooves consumers to be
sure that the physician they choose is board-certified in plastic surgery or the discipline of surgery related to the area of the body in which they seek improvement.
The information as to the qualifications of a physician is readily available, if people would take the time to seek them out. Many spend more time evaluating the automobile they will drive off the showroom floor or a refrigerator they will buy than the plastic surgeon who will operate on their face or body.
The easiest way to find data concerning the qualifications of a plastic surgeon is to call the American Society of Plastic and Reconstructive Surgery via its 800 number. The local medical society can provide information on the training of the physician in the community, as will local hospitals. Visit the library and check out the directory of medical specialists, which describes in detail training, hospital affiliation, and years in practice for all board-certified medical specialists in the U.S.
Board certification ensures that the physician has undergone training to qualify for doing a surgical procedure. It does not guarantee the quality of artistic skill and says nothing for the physician's ability to visualize, conceptualize, or understand the requests and needs placed before him or her. Individuals must feel comfortable with a doctor and feel that he or she is understanding and
compassionate, cares for a patient's emotional stability, and offers the artistry and skill to achieve the desired change in appearance.
Costs vary and frequently are modified when they are combined. For example, a facelift may run $5-7,000 and the eyelids $4-5,000, but, when done together, may cost $7-9,000. Rhinoplasty (nose) surgery may be $5-6,000 and liposuction $3-5,000, depending on the areas and quantity. Hair transplants may cost $20-40 per plug. Breast augmentation can run $4-5,000. Some doctors will charge what the market will bear, varying their prices depending on the Dunn & Bradstreet rating of their clients.
The future of quality plastic surgery may be a tenuous one, with the possibility of flooding the market with unqualified practitioners by doing away with board certification in the name of fair trade. With the increasing presence of prepaid medical plans and socialization, more poorly trained physicians may seek to practice plastic surgery to augment their incomes. The government is lax in control and restrictions, so consumers should be warned that they may not be consulting a trained, board-certified, qualified physician who has experience, talent, and artistic vision and is capable of offering the best chance for success.
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