Cosmetic Surgery - No Longer Just For the Rich and Famous.
Cosmetic surgery once available to only the affluent is now commonly available to a much wider population. According to the American Society of Plastic and Reconstructive Surgery (ASPRS) over one million people underwent cosmetic surgery in 1998. This is more than double the amount since 1992. Of those 1 million patients, one out of three were over 50 years of age. And it is no longer a luxury for only the well to do. In fact, the majority of patents that underwent cosmetic surgery have incomes under $50,000 per year. The most common procedures for patients over 50 are eyelid surgery, followed closely by facelift and then liposuction.
The reasons for this explosive growth are many. Probably the main reason is secondary to an increase in public acceptance. It is no longer taboo to admit that you have had a procedure done and most people personally know someone who has undergone a procedure and they have seen the improvements firsthand. According to the ASPRS the number of people who approve of cosmetic surgery for themselves or others has increased 50% over the last decade.
Other reasons include the booming economy, the affordability of the procedures and the easy availability of financing. Also, as the job market becomes more competitive and youth oriented a growing number of men and women are turning towards cosmetic surgery as a way to promote a more youthful image. Contrary to a widely held misconception, the vast majority of patients are not motivated by vanity or by a desire to obtain an unrealistic physical attribute. They are seeking an alteration of usually a single physical attribute, which they believe promotes a negative self-image, causes stress and limits quality of life. It is common for patients to perceive themselves as a much younger or different person internally, than the image that they see in the mirror. Cosmetic surgery can bring these perceptions in line with each other.
Over the last few years several new developments in the field have helped fuel the growth of cosmetic surgery. They include better surgical techniques, better anesthesia techniques and anesthetic agents, the laser, ultrasonic liposuction and the endoscope. These developments in general have let to shorter recoveries with a quicker return to work, smaller incisions with less scarring, and increased safety.
Last year in the United States there were 120,000 surgical procedures done on the eyelids. Lower eyelid surgery can now be performed through a small incision on the inside of the eyelid. This leaves no visible scar on the outside. Any excess skin or fine wrinkles can be removed with a high tech laser. The laser addresses the skin, and the bags of fat are removed separately. Time out of work is usually 3-5 days and swelling and bruising are usually minimal and are easily camouflaged with make-up.
In 1998, over 70,000 facelifts were performed in the United States . Facelift surgery usually lasts 3-4 hours and can be done with either a local or general anaesthetic. Patients can go home 1-2 hours after the completion of the procedure to recover in the comfort and privacy of their own home. Newer techniques include incisions only behind the ear, behind the hairline or in the mouth while using a specialized endoscope to keep incisions tiny. This is frequently coupled with special techniques and sutures to help support the underlying muscles and prolong the result. If longer incisions are needed newer techniques allow minimizing and hiding the scars in natural creases. For the minor facial procedures return to work can be in 3-5 days or after a weekend. Very few patients want to look “done” and with newer techniques patients can easily achieve a “natural” look.
The newest tool for removal of localized fat is the ultrasonic liposuction. This uses sound waves to break up the fat prior to removal. Currently it if felt that use of the ultrasonic liposuction causes less bruising, less potential for bleeding and may allow for removal of larger volumes. Again allowing for less down time with a quicker recovery and quicker return to normal daily activities.
Finally there are a whole host of non-surgical options that can be done in the office during an outpatient visit that can enhance your appearance. For facial wrinkles there is a wide spectrum of available options that allow tailoring the procedure to the patient. These range from mild facial peels which can be done at home, stronger chemical peels (sometimes known as the blue peel) which is done under the supervision of a physician to a laser resurfacing. Each gives different degrees of improvement to the skin. The milder treatments allow quick recovery on the order of a few hours to a few days. The newer erbium laser as well as the blue peel may allow return to work within several days to one week.
Dermologen is a newer form of collagen that can be injected to improve facial lines, scars and depressions. It is commonly used to improve fine lines around the mouth, eyes and face. The body generally reabsorbs traditional collagen within six to nine months. The advantage of dermologen is it is felt to reabsorb at a much slower rate and may last much longer perhaps permanently.
Botox is also an injectable treatment. Botox allows relaxation of some of the overactive facial muscles that lead to deep dynamic wrinkles. These muscles commonly cause deep lines such as frown lines between the eyes and forehead creases. Injection leads to a more relaxed appearance and a lessening of the creases. Botox is also effective in the crows foot area. However, like collagen, the effects are not permanent.
With so many physicians in the marketplace today, how does a person know which doctor to choose and how to evaluate the doctor? It is recommended that you carefully evaluate your surgeon. Ask to see photographs and to speak with patients who have had the same procedure done. Anyone with a medical or even dental degree may call himself or herself a plastic surgeon even though their qualifications may differ greatly. Board certification by the American Board of Plastic Surgery (ABPS) assures that the physician has graduated from an accredited medical school and completed at least five years of additional residency, usually 3-5 years of general surgery and 2-3 years of plastic surgery. To be certified by the ABPS the physician must also practice plastic surgery for 2 years and pass comprehensive written and oral examinations. The ABPS is the only member board of the American Board of Medical Specialties (ABMS) that provide certification in all aspects of aesthetic (cosmetic) surgery. “The gold standard in plastic surgery is certification by the American Board of Plastic Surgery,” according to Newsweek General Editor, Claudia Kalb, in the August 9, 1999 cover story, “The New Age of Cosmetic Surgery.” Consumers may call the Plastic Surgery Information Service 1-800-635-0635 for informational brochures and qualified plastic surgeons in their area.
Lawrence Rosenberg M.D. is a plastic surgeon in private practice in Baltimore. He is a member of The American Society of Plastic Surgeons (ASPS), and is board certified by the American Board of Plastic Surgery and the American Board of Surgery. He has a surgical facility on premises and has operative privileges at several locations in Baltimore, Howard and Anne Arundel counties.
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