No Longer a Luxury

Cosmetic surgery is no longer a luxury. With heightened awareness about procedures, technological advancements and more affordability, it has become popular across all socioeconomic brackets. Despite the uncertain economic climate—or perhaps because of it—men and women are taking a closer look at what's important to them. Being happy and confident is an emerging notion that is no longer considered selfish or excessive. People realize the importance of cultivating and maintaining inner and outer peace and well-being.

Benefits Exposed

More and more people are exposed to the benefits of cosmetic surgery through television shows and other media. With reality shows such as "Extreme Makeover," dramas such as "Nip/Tuck" and celebrities admitting to having "work done," the general public has become familiar with these procedures and the positive affect they have.

Due Diligence: Your Responsibility

It is true that surgical techniques continue to progress and the downtime associated with these procedures has dipped dramatically. However, individuals interested in pursuing cosmetic surgery need to understand that proper due diligence is their responsibility and priority for finding a surgeon that is right for them. Doing research and educating yourself is paramount.

• Make sure that your surgeon is an accredited and skilled doctor with solid training and extensive surgical experience. Verify a physician's medical license, certifications and professional society memberships. Ask what it takes to be a member or to be board certified in a specialty.

• Ask about the surgeon's medical education and training specific to cosmetic surgery and the procedure that you are considering. How many and how often has the surgeon performed the procedures that you are considering?

• Is the facility accredited? Two nationally recognized accreditation organizations are the Accreditation Association for Ambulatory Health Care (AAAHC), which accredits 3,215 surgery centers, and the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), which accredits 1,100 surgery centers. Achieving accreditation can be a time-consuming, expensive process; some surgeons resist seeking accreditation for these reasons. To earn accreditation, a surgery center must meet quality standards designed to ensure the safe delivery of care to patients. Accredited facilities undergo on-site inspections every three years to ensure adherence to standards and to demonstrate improvement in quality of care. 

• Look for surgeons’ credentials on national online directories, such as those of the American Academy of Cosmetic Surgery Web site http://tinyurl.com/24cfh4m, and HealthGrades, http://tinyurl.com/2ckead5. Search for the surgeon on Google and ask around.

• Be sure you understand and accept which procedures are appropriate for you. Set realistic expectations.

• Do you have a comfortable rapport with your surgeon? Do you feel at ease with the staff? Much of your communication will be with them. Do they address your concerns to your satisfaction? Don’t settle for an incomplete answer from anyone.

• Don't be fooled by false promises or “bargains.” Despite the fact that prices for cosmetic surgery in the United States have stabilized and, in some areas, dropped, there are still those who opt for low-priced vacation surgery packages in foreign countries with surgeons with inadequate specialist skills and training.

Unfortunately, we have witnessed an increase in the number of patients seeking second opinions for revision surgery; they’re desperate for us to fix what went wrong. In most cases, correcting an unfavorable outcome may take several surgeries, resulting in longer recovery time, greater discomfort than originally expected, results that probably won’t be as good had the surgery been performed correctly from the start and, of course, much greater expense.

Lunchtime Procedures

We have recently experienced an upswing repairing work poorly done. Minimally invasive surgeries have captured the attention of many who want the sublime and natural-looking results of a five-hour long surgery in less than 60 minutes, at the price of a six-course degustation dinner in an upscale restaurant.

These "lunchtime" procedures are designed to restore your jawline; address wrinkles and frown lines; remove excess fat; and tighten droopy skin on face and neck with no downtime. They claim to be safe and easy and to have you back at work quickly, with lasting and more affordable results.

While such procedures may turn out well for some patients, many have endured not only disappointing results, but unfortunate complications and irreversible damage. Be wary of procedures that offer a "one size fits all" approach regardless of age, facial structure or degree of skin aging. In the end, looking for a quick, easy and cheaper fix through plastic surgery is not recommended. Protect yourself, especially your face and body. Above all use common sense: choose your cosmetic surgeon as you would any other health-care provider.

Your Search Pays Off

Respected and talented surgeons are willing to communicate with you at length to make sure you understand the procedure, the process needed for recuperation and its realistic outcome. They are available to you at any time before and after the procedure to ensure that all goes well and that you feel safe and comfortable. At the North Shore Center for Facial Plastic & Cosmetic Surgery, all patients can access their surgeon 24 hours per day, seven days per week, through the healing process and beyond. 

Beginning Your Transformation

By educating yourself and holding realistic expectations, you’ve opened up a world of possibilities through cosmetic surgery. You’ve chosen to enrich your life, improve your self-esteem and be more in tune with the person you know you are. Life expectancy is on the rise, so why not make your 60s your new 40s? When you decide whether to have cosmetic surgery, follow your heart—and education—and do what feels right for you.

Statistics from the American Society for Aesthetic Plastic Surgery (ASAPS) show that almost 2.8 million BOTOX procedures were performed last year. BOTOX has been the most popular cosmetic procedure since 2000, and the number of procedures performed has increased 82% in the past five years. But amidst all the positive reports of the benefits of BOTOX are some disturbing trends. In particular, reports of so-called “BOTOX parties” have raised red flags for many medical professionals.

According to ASAPS, the leading organization of board-certified plastic surgeons who specialize in cosmetic surgery of the face and body, BOTOX treatments are safe when performed by a qualified clinician in an appropriate setting. However, before undergoing BOTOX injections at a party, or anywhere else, make sure you can answer “Yes” to the following questions:

• Have you been asked to provide a complete medical history? A patient should fully disclose any medical conditions you might have, and medications you are taking including vitamins and over-the-counter drugs. This information will help your clinician select the most effective procedure for you, with the fewest side-effects.

• Have you been advised on alternative treatments? Part of the purpose of a pre-treatment consultation is the thorough evaluation of each patient for whatever treatment is being proposed. In the case of BOTOX, not everyone is an appropriate candidate. For some patients, other treatments or even a surgical procedure may be more effective. No one should undergo any nonsurgical treatment without personal evaluation by a qualified physician.

• Have you been advised of the risks and given your informed consent? A patient should make sure the benefits and risks are fully explained in a patient consultation. Plastic surgeons use the consultation process to educate patients about the proposed procedure. Every procedure has inherent risks and benefits; the hallmark of informed consent is the understanding of risks and benefits, and realistic expectations.

• Is a qualified clinician administering the treatment? While BOTOX treatment is both safe and effective, every medical procedure has risks and possible complications. It is imperative that BOTOX be administered by an experienced clinician who understands facial anatomy and proper BOTOX injection techniques.

• Is the physical setting appropriate for administering medical treatment, including handling emergency situations? Any injectable should be administered in an appropriate setting using sterile instruments.

• Do you know what you are being injected with? Disturbing reports of patients being injected with everything from liquid silicone to baby oil and other unapproved products are appearing in the press on a regular basis. Currently BOTOX-Cosmetic manufactured by Allergan is the only form of Botulinum Toxin that is FDA-approved for purchase within the United States.

• Are you willing and able to follow post-treatment instructions? BOTOX treatment requires that the patient restrict physical activity for a period following the injections. Failure to follow post-treatment instructions can lead to complications. In a party atmosphere, people may tend to forget such restrictions, particularly if alcohol is being served.

• Will you receive adequate follow-up care? BOTOX is a temporary treatment, and results usually last only a few months. Nevertheless, follow-up care is an important part of the doctor-patient relationship, and should not be overlooked, even when treatment is administered outside of the usual medical setting.

“BOTOX parties” may offer some benefit to patients by reducing the cost of their individual treatment. However, unless proper measures are in place to ensure both safety and effectiveness of treatments, ASAPS advises that you enjoy the party, but get your BOTOX injections in the doctor’s office.

Source: "Botox 'Parties' Not Just Fun and Games, Advises The American Society for Aesthetic Plastic Surgery," American Society for Aesthetic Plastic Surgery (ASAPS) (http://www.surgery.org/) news release, New York, New York, May 19, 2008

The old saying, “beauty is in the eye of the beholder,” has scientifically been proven true. A study in a recent issue of Plastic and Reconstructive Surgery^®, the official medical journal of the American Society of Plastic Surgeons (ASPS), found that variations in eyebrow shape, eyelid position, and wrinkles significantly impact how your facial expressions, and subsequent mood, are perceived by others.

“A key complaint of those seeking facial plastic surgery is that people always tell them they look tired, even though they do not feel tired,” said John Persing, MD, ASPS member and study co-author. “We found that variations in eyebrow contour, drooping of the upper eyelid, and wrinkles may be conveying facial expressions that don’t necessarily match how patients are feeling.”

In the study, a standardized photo of a youthful face was digitally altered to change a number of variables, including eyebrow shape and position; upper and lower eyelid position; upper eyelid drooping and removal of excess skin; and facial wrinkles. Twenty health care workers were given 16 photos and asked to rate, on a scale of 0 to 5, the presence of seven expressions or emotions: tiredness, happiness, surprise, anger, sadness, disgust, and fear. The results for each altered photo were compared with scores from the original unaltered photo. Overall, eyebrow shape had a greater influence than absolute position on perceived mood.

Tiredness

Drooping of the upper eyelid was the biggest indicator of tiredness, according to the study. Simulating skin removal of the upper eyelid, as performed in some eyelid procedures, but not correcting accompanying eyelid ptosis (drooping), resulted in an increase in the perception of tiredness (and sadness). Photos that included an overall elevation of the eyebrows or an increase in the distance between the eyebrow and upper eyelid also increased the perception of tiredness.

Anger and Disgust

Lowering or slanting the inner corner of the eyebrows towards the nose, as well as adding forehead wrinkles significantly increased the perceived facial expressions of anger and disgust.

Fear and Surprise

Raising the upper eyelids produced an increase in the perception of surprise and fear. Also, raising the outer corner of the eyebrows produced an increase in the perception of surprise.

Sadness

Raising the inner corner of the eyebrows away from the nose was perceived as a sad facial expression.

Happiness

Happiness was perceived by raising the lower eyelid and the presence of crow’s feet, which, according to the study, seem to simulate the cheek elevation that occurs with smiling.

“The eyes and their related structures nonverbally communicate a wide range of expressions that are universal to all people,” said Dr. Persing. “Therefore facial expression should be a factor in how patients and their plastic surgeons select various rejuvenation procedures. As our findings show, even the slightest modification can elicit profound changes in how others perceive us.”

According to ASPS statistics, more than 241,000 eyelid surgeries, 43,000 forehead lifts and 118,400 facelifts were performed in 2007.

Source: "Looking Tired or Angry May Have More to do with Facial Aesthetics Than How You Feel, ASPS Study Reveals," American Society of Plastic Surgeons news release, Arlington Heights, Illinois, May 27, 2008

The American Academy of Cosmetic Surgery (AACS) released results from a consumer survey asking 1,000 women about medical spas. Findings revealed that millennials (those born between 1976 and 2001) are the primary customers of these facilities. Yet half of those women are compromising their safety by visiting a nonphysician-supervised medspa facility. Women ages 18–34 were more than three times as likely as women ages 35–64 to undergo a noninvasive cosmetic procedure such as BOTOX^® at a medical spa.

Conversely, from 2002 to 2007, the mean age of patients seeking the top ten most-performed invasive procedures increased by two years, making the baby boomers the driving force of liposuction and facelifts. AACS President Steven Hopping, MD, FACS, commented that the younger the patients, the more likely they are to visit a medical spa to undergo a noninvasive procedure such as BOTOX.

The survey confirms that younger patients are less vigilant about safety at a medical spa. Two-thirds of those surveyed indicated that they would hope to be treated by a physician when visiting a medical spa. However, among women who had an opinion, more than half (52.3%) indicated they would be comfortable if the physician were not present during a noninvasive cosmetic procedure performed at a medspa.

"This consumer survey is a chance to once again emphasize the importance of patient safety, and to educate the public on these facilities," said Dr. Hopping. "There are good and bad medspas out there and we want the public to be aware, ask questions and always make sure there is a qualified physician doing the procedure. If not, don't have it done."

THE SKINMEDISPA, as part of the North Shore Center for Facial Plastic & Cosmetic Surgery, earned the prestigious AAAHC accreditation. All procedures in the medical spa are performed by a qualified medical esthetician under Dr. Geroulis’s supervision. “It is not that the physician sits on some remote board as a symbolic figure or, as with many medical spas, is not even involved in any aspect of daily patient care. There is a physician physically on the premises at all times, so patients with a question or concern can see the doctor immediately. Furthermore, all dermal injections such as BOTOX, Restylane^® and Radiesse^® procedures have always and will always be administered solely by a qualified physician.

THE SKINMEDISPA prides itself on adhering to the strictest patient safety regulations set by national standards, one reason the center has consistently been awarded and recognized for its high standards of quality control.

Source: Medical News Today, June 25, 2008

A recent report suggests that, despite worries over an economic downturn, Americans are still spending money on procedures intended to make them look better. The annual report, issued on April 7, 2008, by the American Society of Plastic Surgeons, showed that the number of cosmetic procedures performed continued its steady rise last year to a total of nearly 12 million. But while consumers continue to flock to doctors in the hope of improving their appearance, plastic and cosmetic surgeons and dermatologists say there are a number of procedures of which consumers should be especially wary. The entries listed here represent cosmetic procedures that are least likely to offer results that justify their risks.

A Jab to Dissolve Fat? Mesotherapy and Lipodissolve

Several cosmetic surgeons and dermatologists agree that, if there is one procedure to avoid when shopping for a slimmer look, it's "lipodissolve," a shot that is purported to dissolve stubborn fat deposits. This shot is often part of "mesotherapy," a shallow injection of a cocktail of substances using a fine needle.

"There is really not a single scientific study to show that it definitely works," said Dr. Malcolm Roth, director of plastic surgery at Maimonides Medical Center in Brooklyn, N.Y. "Are these chemicals safe when injected into fat? And what happens to this fat? Where does it go?"

And Dr. Carolyn Jacob, a board-certified dermatologist in Chicago, calls lipodissolve the most ill-advised treatment available today. "This is a non-FDA-approved use of a material called 'lipostabil,' which can dissolve fat and other structures. However, it can cause pain, swelling, hard lumps, ulceration of the skin and contour irregularities."

"None of the pharmaceuticals used for injection are FDA approved," said Dr. Susan Kaweski at the Aesthetic Arts Institute of Plastic Surgery in San Diego. Despite the dangers of the procedure, the growing number of clinics offering lipodissolve is a testament to its continued legal status in the United States. Still, the procedure is banned for cosmetic purposes in Brazil and other countries.

A Sexier Step: Cosmetic Foot Surgery

Those who desire cosmetic surgery from top to toe should be no stranger to cosmetic foot surgery, a collection of surgical and minimally-invasive procedures designed to yield a sexier foot. Despite the continued popularity of these procedures—which involve everything from filler injections to rounding out angles to total surgical reshaping of the foot—doctors have been warning consumers away from cosmetic foot surgery for years.

"The public needs to be aware of the risks associated with these procedures," said American Orthopaedic Foot & Ankle Society (AOFAS) president Dr. Glenn B. Pfeffer. "Women need to know what they are getting into."

He noted that the trend toward the practice of cosmetic surgery raises serious concerns when one considers the risks of surgery on pain-free feet. "Complications can include infection, nerve injury, prolonged swelling of a toe and even chronic pain with walking," Pfeffer said.

Not surprisingly, the sector of consumers that tends to be the most enthusiastic at the prospect of better-looking feet are women who hope to adorn their feet with the latest in strappy, high-heeled fashions.

And the procedures involved run the gamut from filler injections to full-blown surgery to reshaping the foot. The AOFAS noted that surgery to shorten the toes or narrow the feet are favorite options in this category. Some practitioners will also inject the fat pad of the feet with collagen or other substances—again, solely to change the appearance of the feet.

Injection for Breast Augmentation

What if getting bigger breasts were as simple as getting a shot?

The idea is not a new one, and it stands to reason that pumping the breasts full of fat or fillers would offer an alternative to breast implant surgery—all without the scars.

Traditionally, doctors performing such procedures have used the fat harvested from other areas of the body, such as the buttocks and thighs. By purifying this fat and reinjecting it into the breasts, they say they can offer their patients a safe enhancement using the body's own spare materials.

But, in reality, the procedure is not nearly as simple as it appears.

"On the surface, the concept of using liposuction to remove unwanted fat from one's own thighs and buttocks, and then injecting it into the breasts to make them larger, has appeal," the American Society for Aesthetic Plastic Surgery noted in a past statement on the procedure. "However, aesthetic surgeons certified in plastic surgery have long maintained that injection of fat, or any substance, into or behind the breast tissue can be potentially dangerous."

Dangerous, because there exists the potential for the reinjected fat to calcify, creating a scarred mass buried within the breast tissues. These calcifications can either mask or mimic the presence of breast cancer. And since between 7 and 14 ounces of fat are needed for the enlargement of a breast, there is no shortage of relocated fat to make the detection of breast cancer difficult, or even impossible.

Cosmetic Leg Lengthening Surgery

How far would you go for a few more inches of height? For some, the quest for a more impressive stature leads them to a painful procedure that involves breaking both legs and using devices with screws attached to their legs to gradually extend their bones.

It's an extreme procedure to be sure. Yet, the technique is widely known in China and other Asian countries, where young professionals seek out the procedures to give themselves an edge in the business world.

But the procedure is also well known in the United States. Robert Rozbruch, the director of the Institute for Limb Lengthening and Reconstruction in New York, told ABC News that he does not approve of leg lengthening for cosmetic purposes as a new cosmetic surgery trend. And the patients who come to his center can receive the surgery only after extensive psychological testing.

But the results don't come cheap. Costs of the procedure generally top out at $120,000. For an average height gain of 3 inches, that's $40,000 per inch.

For those of a very short stature, the results may be worth the price tag and the pain. But the procedure is a poor choice if vanity is the main motivation.

Permanent Filler Injections

Most of the fillers that are on the market today are temporary: after a certain amount of time they are absorbed into the body and the results are lost. This group of fillers includes the natural filler collagen, as well as a number of newer gels such as hyaluronic acid.

But some fillers are designed to stick around in the body for longer periods. These fillers, appropriately termed "permanent fillers," include liquid silicone and the product known as "Aquamid."

Though tantalizing to some consumers who would prefer to pay for fillers once rather than shell out for repeat procedures, such fillers have also been known to lead to a number of complications, including irreversible binding with tissues and a tendency to "drift," which can lead to a distorted appearance.

The problems become even more severe in the event of a botched job.

But despite widespread disapproval among cosmetic surgeons and dermatologists, many consumers still seek out permanent filler injections.

Buttock Implants

While many people hit the gym and suffer through crash diets to attain a smaller behind, there are others who actually seek out surgical solutions for a larger, rounder butt. For these people, cosmetic surgery can offer buttock implants. Unlike breast implants, which are filled with either silicone gel or saline, buttock implants are solid slabs of silicone, positioned beneath the fibrous lining of the buttock muscles.

The result is a rounder, more voluminous rear end. But this result comes at a price for many patients. Among the problems is an increased risk of infection: to hide the incision from plain view, surgeons will often place it between the buttocks, perilously close to the anus and the germs that reside there.

And even after the incisions have healed, the implants are situated in an area of the body that endures its share of daily abuse.

Made Up for Life: Tattooed Makeup

Many women may dream of skipping their makeup routine in the morning. For those who opt for permanently tattooed makeup, the reality can be more like a nightmare than anything else.

"I have had more than my share of patients who ask me to remove the permanent makeup tattoo that someone else gave them, and I will tell you that they're difficult to take away," said Dr. Malcolm Roth, director of plastic surgery at Maimonides Medical Center in Brooklyn, N.Y.

Much of the difficulty in removing these tattoos is owed to the fact that the tattooed areas are some of the most delicate tissues of the face, namely, the inner folds of the eyelids and the lips. And even with today's complement of high-tech tattoo-removal lasers, there is never a guarantee that the tattoos will disappear completely.

This is especially bad news for those who have received botched jobs from untrained practitioners. But even for those who get what they want in the short term, their long-term satisfaction with the job may still be in question.

If you don't like the results, you may still be stuck with them. And even though you might like the result in the short term, fashions change.

Any Procedure by Untrained Hands

With the explosion in the popularity of cosmetic surgery in the past two decades has come another explosion in the number of people who are willing to perform these operations.

"Probably everyone has heard of the itinerant practitioner who performs procedures in a hotel room for bargain basement prices and then is nowhere to be found when complications arise," Dr. Gregory H. Branham, associate professor and chief of facial plastic and reconstructive surgery at Washington University in St. Louis, said.

So what is the key to avoiding such practitioners? Do your homework, and don't rush into surgery before you know everything you need to about your surgeon.

And when in doubt, don't go through with the procedure. You never regret the operation you don't have.

Source: 10 Cosmetic Procedures You Should Avoid: The Potential Aesthetic Benefits of Some Procedures Aren't Worth the Risk, by DAN CHILDS, ABC News Medical Unit, April 7, 2008