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Serenity Through Surgery?...

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June 6, 2001 Article Level: Advanced

Serenity Through Surgery?

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Wendy Meyeroff, Medical Writer

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The idea of celebrities undergoing cosmetic surgery is nothing new. But if you think that more "average" people are also undergoing a variety of cosmetic procedures, you're not imagining things. Such procedures are no longer strictly the province of the famous (or rich).

A recent study by the American Society of Plastic and Reconstructive Surgeons (ASPRS) notes that cosmetic procedures increased by 50% over the last 2 years. The society started tracking both cosmetic procedures (done mainly for the sake of aesthetics) and reconstructive surgeries (done to repair something, like breast reconstruction after a mastectomy) in 1992.

The most common procedures (not all of which are, strictly, surgery) are liposuction (fat suctioning) and breast augmentation. (See the chart for the top ten procedures among men and women.)

Why are such procedures attracting "the masses"? Paul Schnur, MD, chairman of the Division of Plastic Surgery of the Mayo Clinic (in Scottsdale, AZ) and president of the ASPRS, says, "Plastic surgery isn't a secret anymore. You almost can't pick up a women's magazine, for example, without seeing something about it." Indeed, a 1998 survey of the American Society for Aesthetic Plastic Surgery (ASAPS) notes that 78% of women and 71% of men wouldn't be embarrassed if those outside of close friends and family knew they'd had cosmetic surgery.

Dr. Schnur lists two more key reasons Many patients are in for the rising popularity: "People have search of an impossible discretionary money and this has perfection, often become another way for them to spurred by unrealistic 'splurge,' like buying designer clothes. media images.

Also, people are living longer, so they want to look good longer."

Renato Saltz, MD, associate professor at the University of Utah in Salt Lake City, notes that technology has played a major role.

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"Instruments like endoscopes and lasers allow us to do less invasive procedures." That means less scarring, less pain, and less downtime. The working person can be back on the job in 2 weeks...or less.

Technology also allows for more outpatient surgery, so costs have come down. For example, one New Mexico practitioner's Web site lists the following prices: $3,000 for a forehead lift, $2,000+ for skin "resurfacing" (for example, laser smoothing), $4,750 for breast reduction, and $1,500+ for male hair transplants.

Amy Flowers, PhD, a psychologist with Focal Pointe Women, in Macon, Georgia, says a competitive job market for aging "boomers" is another factor. "It used to be that cosmetic procedures were relegated to industries where image was critical, such as acting and modeling." Today, she says, people with "regular" jobs seek image enhancement, like the 50-year-old male exec who is nervous about competing with a 30-year-old. Jim Wells, MD, a spokesperson for Plasticos, a practice in Long Beach and Huntington Beach, California, believes that as the "glass ceiling" disappears, women will face the same job-related image pressures.

So, is indulging in this new "luxury" a good thing? Like everything, says Dr. Flowers, it has its good and bad points. "If you've never liked your nose," she says, "and changing it will help you feel more self-confident, that's fine."

Unfortunately, many patients are in search of an impossible perfection, often spurred by unrealistic media images. A television camera now exists, Dr. Schnur says, that creates a slight delay in transmission, and during that time the image it contains is enhanced before being sent on its way (so that accurate, "live" picture of your news anchor may be neither).

And for magazine ads, computers now commonly recontour the model's chin, reshape her eyes, and perform other tricks no surgeon can match.

Chasing such images is bad enough, but there are always patients with totally unrealistic expectations. Dr. Wells points out that liposuction won't reduce a 300-pound patient to 180 pounds. And he refused to operate on a Japanese patient who came in waving a picture of a round-eyed, fair-skinned Scandinavian, and saying, "I want to look like this."

Dr Saltz admits that a determined patient "can always find someone" to do a procedure, but he adds, "I don't think you'll see too many board-certified surgeons" who'll do unrealistic work, or the kind of unending surgeries that give cosmetic procedures a bad name. Dr. Flowers believes patients wanting cosmetic surgery should undergo psychological testing to determine the real reason for their desire. The surgeons don't go quite that far, but all say they have extensive one-on-one meetings with prospective patients. Dr. Wells says he tries to delay surgery at least 2 weeks. Besides helping patients reevaluate their decision, "it helps my staff evaluate patients. If someone calls every 2 days, is impatient, rude, and disagreeable, I know this is not the kind of person who has the patience for the work."

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Serenity Through Surgery?...

Ultimately, Dr. Wells offers this summation: "Consult at least two, maybe three physicians before proceeding. And if any doctor pushes you too hard, back off."

Top 10 Cosmetic Procedures For Women

Chemical peel Collagen injection Sclerotherapy (treatment for leg veins) Liposuction Cosmetic eyelid surgery

For Men

Nose reshaping Hair transplantation Liposuction Laser hair removal Cosmetic eyelid surgery

(Source: ASAPS 1998 Statistics on Cosmetic Surgery)

Before Going "Under the Knife" Dr. Wells emphasizes that patients planning to have a cosmetic procedure should do their homework. Unfortunately, many check out their doctor less carefully than they do a prospective new car, he says.

Here are the points experts urge you to consider: 1. Is your doctor board-certified? Technically, anyone with a medical degree can become a cosmetic surgeon and doctors like the work because they don't have to wait for insurance payments. (See #6.) To find someone truly qualified, find out whether they are certified by well-recognized boards that represent true specialties.

(Also check to see if your doctor has hospital credentials. That's another mark in his favor.)

2. Is the doctor's office accredited, and if so, by whom?

Many procedures are being done in doctors' offices, so these offices should be sanitary, have emergency equipment and properly trained staff, and adhere to other strict standards.

3. Does your doctor truly discuss the pros and cons with you, or does he or she just say, "No problem"? If the latter, run, don't walk, to the exit. 4. Do you truly understand the risks? Remember that even with today's technology, surgery is still surgery. There are always risks and scars (For instance, see an article in the May 13, 1999, issue of the New England Journal of Medicine, "Deaths Related to Liposuction.")

4. Has your physician discussed problems related to your skin type? Dark skin, for example, tends to show scars more readily and may not be suitable for some procedures. http://cbshealthwatch.medscape.com/cx/viewarticle/200645 (3 of 4) [6/6/2001 1:32:29 AM]

Serenity Through Surgery?...

5. What are the total fees? The fees cited as examples are the doctor's fees. There are other charges that get tacked on: anesthesia, supplies, hospital costs (if necessary).

6. Who's paying for this? Aesthetic procedures are generally not covered by insurance or flexible spending accounts, so everything comes out of your pocket.

7. Do you understand that you may look worse before you look better? Many procedures, including laser resurfacing, can cause swelling, redness, and other temporarily disfiguring conditions. Make sure you are psychologically prepared for this before deciding to undergo a procedure.

8. Are you willing to follow the doctor's instructions?

There's no point in having skin resurfaced if you insist on baking in the sun and refrying it.

Most importantly, why are you doing this? If you expect a procedure to make you totally happy, forget it. Also, Dr. Flowers notes, too many women succumb to men who say, "If you really loved me you'd have that breast surgery." Forget such a man, she says...and find one who'll love for yourself.

Wendy Meyeroff has been a professional medical writer since 1978.

Reviewer: Beth Israel Deaconess Medical Center. Reviewed for medical accuracy by physicians at Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School. BIDMC does not endorse any products or services advertised on this Web site.

Source: CBSHealthWatch Copyright: Š 1999 Medscape, Inc. Posted On Site: Oct. 1999 Publication Date: Oct. 1999

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