Mirror Image: A Guide to Plastic Surgery in Dallas

Plastic surgery is no longer just about vanity. it’s about looking as good as you feel. local surgeons talk about new techniques and non-surgical alternatives that will lift your spirits as well as your face.

Take a good hard look in the mirror. Don’t like what you see? Not to worry. That face isn’t the future you’re looking at; it’s your past. Today more than ever, plastic surgery is socially acceptable, safe, and simple. Surgeons can nip, tuck, sand, knead, and suck your face and body into an outward reflection of how you feel, putting the finishing touches on what you and your personal trainer have begun.

The changes can range from subtle to drastic, the procedures from gentle to radical. It’s up to you. D takes a look at the pros and cons of plastic surgery: what’s available, who’s the best, how much (or surprisingly little) it costs, and—most important—whether it’s right for you.


Who’s the fairest of them all?

Dr. H. Steve Byrd sees a lot of baby boomers these days—executives in their mid to late 50s who want face lifts and liposuction to make them look younger.

Why? Because they’re competing with 30- and 40-year-olds who still have gravity and youth on their side.

One of his patients, a woman in her 50s, was promoted three months after her face lift. Coincidence? Maybe. But she told Dr. Byrd she’s convinced the surgery elevated more than her drooping skin.

Dr. Warren Katz, a plastic surgeon known for his work on the face, sees a lot of divorcees, widows, and older women entering the workforce after raising their children. This is a whole new era for professional women. "I had a patient who was a real estate broker," says Katz. "She was in her 60s. Clearly such a profession depends on style and presentation. The irony is that as we get older, we know more and more.

"It’s the same for men, too, but men have it slightly different. Men have always looked older and bigger and been head of the bank. Historically, women haven’t had that place in the hierarchy like they do today.

"Now they need to compete with the 30-year-old, computer-oriented set as they enter the job market," he says. "A man at 45 or 50 in a corporation has worked his way up the ladder. People treat you the way you look and the way you act. A woman at 45 who spent 20 years raising kids needs to look terrific."

Yet that woman often needs "permission" to have plastic surgery. Many have a difficult time getting past the guilt of using time and money for an elective surgery.

"Many of my patients come in to talk and really just want somebody to relate to what they’re going through," says Dr. Brenda Draper, a local surgeon who likes to see her patients at least twice before she performs a procedure on them to be sure they understand what to expect—good and bad. "They want me to relate to the things that bother them and, in some ways, give them permission to have them fixed. I tell them they’re not being vain. It’s okay. Most don’t want major changes. They often just want to freshen up some part of themselves so it’s less of a focus."

Mirror Image: A Guide to Plastic Surgery in Dallas

Dr. Alfredo Rodriguez says he has noticed an increase male baby boomers having plastic surgery, 40- and 50-year-olds who are out in the job market. Surgery around the eyes is often their answer to the younger faces they see across the board table.

"The eyes are the first area to show age that people see," Rodriguez says. "They usually don’t want a face lift at this point. They just want to look more competitive."

Dr. Diane L. Gibby, one of the first and few female plastic surgeons in the Dallas area, sees the same trend and worries about what that says about our society.

"It’s kind of sad, I think, to feel we have to change the way we look in order to be competitive," says Gibby, who sees primarily professional women in her practice. "I have an awful lot of patients who are certainly not old by any standards coming to me because they’re competing for jobs with people out of college in their early 20s."

More seniors over the age of 65 are having cosmetic procedures done, too, making up 9 percent of all such procedures in the United States. A 1998 study shows a 113 percent increase in procedures for seniors, from 42,497 in 1996 to 90,911 in 1998. One-third of the men interviewed in that study said they decided to have work done on their face for work-related reasons.

Most people are beyond the point of lying about their plastic surgery. The increasing number of famous folks who casually discuss their surgeries with the world has made it socially acceptable. And procedures are considered quite safe, if you have a qualified surgeon doing the work.

Liposuction: Less is More

Liposuction is the number  one cosmetic procedure done in Texas (with 9,806 done in 1998), and Dallas leads the way, local surgeons say. It’s the most popular surgery for men and women.

Although technology allows surgeons to remove more fat during liposuction than in the past, most won’t operate on patients that aren’t within their normal body weight. "The emphasis used to be on how much fat you could remove," according to Dr. Robert Hamas, one of the first plastic surgeons to train in liposuction. "Now it’s more liposculpture. The shaping is more important. Liposuction is not a weight-loss procedure. Somebody who is 5-foot-4 and weighs 200 pounds is not a good candidate. Somebody who is 5-foot-4 and weighs 130 pounds may be a great candidate."

We are in our second decade of liposuction, a procedure during which a surgeon uses a small, straw-like cannula to suck the fat out of select areas—usually around the stomach and love handles for men; the stomach, thighs, hips, and butt for women. Using a relatively new "tumescent" procedure, surgeons pre-inject the area to be treated to hydrate it, allowing fat cells to come out through a smaller tube.

Ultrasonic-assisted liposuction (UAL) is a new and supposedly improved procedure approved by the FDA a few years ago. Some surgeons thought this would replace traditional liposuction, but many, after using it on patients, have decided to stick with the traditional methods.

The hope was that the new procedure would produce less bleeding, bruising, and pain. But surgeons have to use a larger cannula, and the procedure goes quite quickly, giving surgeons less control and creating more complications, such as the possibility of removing too much fat, they say. Many patients experienced more pain, a longer recovery period, the same amount of bruising, and more scarring with UAL.

Dr. Gibby likes UAL, saying the new procedure is quite helpful on patients who want a large volume of fat removed or want the fat removed from more fibrous areas, like the abdominal area or upper back. Unlike UAL opponents, Gibby says she finds her UAL patients do have less swelling and bruising.

"It does make the surgery longer, which may be why many surgeons don’t like it," she says. "You’re really doing the procedure twice because you do the UAL and then the traditional."

Sherry Harvey, a 53-year-old Dallas resident, went to Dr. Katz five years ago for liposuction. "When I started going through menopause, I started getting fuller in the hips and stomach," she says. "I’ve always worked out, but it was just a stage-of-life thing. I wanted to be able to wear shirts tucked into my slacks again." An older friend once told her, "Darling, there’s nothing to aging. Just have a good plastic surgeon." And Harvey says she does.

The surgery took her down two sizes. She’s gained 10 pounds and lost 10 pounds here and there, but the fat doesn’t build back up. The contouring gave her back the body she had before menopause.

Rodriguez has also used a newer procedure called external ultrasonic liposuction. With external UAL, the surgeon uses the ultrasonic paddle on the outside of the fatty area. The thought, although many surgeons disagree, is that this will cause less trauma to the patient than the internal version. Rodriguez, who uses UAL and its external version on some patients but usually sticks to the traditional method, is waiting for all the studies to come in before fully embracing this new procedure.

Mirror Image: A Guide to Plastic Surgery in Dallas

The Great Breast Debate

Breast implants have recently entered their second phase of controversy.

The early ’90s was the age of silicone fear. FDA studies in the mid-’90s vindicated the substance, but it took a while for the public to trust implants again. (In fact, Gibby says, most of her patients still trust saline more than silicone.)

These days, FDA rules prohibit plastic surgeons from inserting silicone implants into first-time breast augmentation patients; saline implants are the replacement. But you can have silicone if you’re having your second surgery and had silicone before, if you’ve had cancer, or if you’re getting a breast lift. Regardless, the rest of the world just uses silicone, surgeons say, rolling their eyes at the inconsistent regulations.

The new issue is the shape of the implants.

A few years ago, Dr. John Tebbetts, a Dallas plastic surgeon, developed the tear-shaped, or anatomical, implant. He believes these implants will last longer and that giving a woman a choice is an important breakthrough. But other plastic surgeons say the traditional round implant is less expensive, easier to insert, and looks quite natural.

Interestingly, last year the FDA made McGhan Medical Corporation, who manufactures the anatomic implant, pull its national ads that touted the implants as "anatomic" and "natural." The May 2000 ruling said the term "anatomic" was inappropriate and should be replaced by "contoured." Dallas attorney Marc R. Stanley filed a class-action lawsuit in May against McGhan, representing possibly 100,000 people—many from Dallas—who claim fraudulent marketing against the manufacturer.

Tebbetts, who is criticized by other surgeons for making money off each anatomical implant sold, says he worked seven years to develop the anatomical implant simply because he wanted a better implant. Because of the way a round implant is designed, the upper shell of the implant collapses somewhat, making Tebbetts believe it will wear out sooner. How soon, he’s not sure. But he also thinks tear-shaped implants look better.

"I designed my implants to prolong the life of the implant, not to be more natural," he says. "But the bottom line is if a patient wants round-looking breasts, get a round implant. If you want natural-looking breasts, use an underfilled round implant or an anatomic implant."

Gibby says she uses anatomic implants about 60 percent of the time. "They have a very good shape for women who desire a subtle sloping appearance to the upper part of the breast," she says. "But I don’t think it’s the implant for everyone. The woman who doesn’t do well with the anatomic implant is the woman who has a broad rib cage. The anatomic is really narrow, and you want the implant to be proportional to the rib cage."

She also uses them on women who have very small breasts to begin with; a larger-breasted woman, she says, wouldn’t be able to tell as much difference between the anatomic and round implants.

Denise Dyer is a believer in the anatomic implant. After breast-feeding her son, her bra size went down from a 34C to a sagging 34A/B. She wanted to look natural so she went with anatomic implants, saying the round implants remind her of Baywatch.

"They look good," Dyer says now of her breasts. "I was thinking they’d probably still be saggy. But they look like they belong on a 15-year-old."

Hamas disagrees with the Baywatch comparison.

"If a patient is upright, the round implants have a similar shape to a teardrop just because of gravity," says Hamas, who recently won an award for his study showing that the anatomic and round implants were nearly identical in an upright position and that round implants look more natural when a woman is lying down.

Rodriguez, who usually uses the round implant unless a patient has her mind set on the teardrop shape, says most surgeons around the country still use the round implants. He does, however, think the anatomic implant is a great solution for reconstructive surgery after a mastectomy (agreeing with Gibby that the less breast tissue you start with, the more the teardrop shape is noticeable).

Dr. George Toledo, a Highland Park plastic surgeon, used the anatomical implant exclusively for two years. It sits in his sample drawer with several other round implants for patients to choose from, but he rarely uses it anymore, he says. One reason is that the implant must be inserted exactly symmetrically and can’t later rotate or it will look off center.

"Most women need more fullness up above," he says. "This [implant] gives them more fullness in the bottom of the breast, which is not what they want."

Tebbetts isn’t only known for his anatomic implants. He also designed a cohesive silicone implant that has been used in Europe for 10 years and was recently approved by the FDA for trials in the United States. And he touts his ability to perform an implant so delicately that patients have a 24-hour recovery—compared to the normal recovery period of a few weeks—and require no bandages or special bras. Tebbetts defends his ground, saying surgeons just aren’t experienced with the anatomical implant.

"If a surgeon recommends only one technique as best, that’s probably what the surgeon knows how to do," he says. "There is no such thing as one best set of choices—only different sets of trade-offs."

Of course, now we’ve got something even more intriguing: the Brava. This device, which just recently hit the market, might even scare Madonna. The intimidating bra-like device consists of two hard plastic shells linked by tubes to a suction pump. Doctors were skeptical, but the Brava apparently really can increase your breasts about a cup size if worn for 10 hours every night for 10 weeks. How? The Brava stretches the tissue, causing cell growth, by using a gentle suction. At $2,500, it’s about half the price of traditional surgical augmentation.

Mirror Image: A Guide to Plastic Surgery in Dallas


The New Face Lift

The face lift that makes you look like your skin could pop and your eyes could fly out of their sockets at any moment is a thing of the past. The new lift takes each section of the face into consideration. Each doctor seems to have developed his own version of the new face lift.

Dr. Byrd prefers an endoscopic, mid-face lift, the "scarless face lift." Dr. Hamas does a brow lift that raises the deeper tissues under the forehead instead of just moving the skin into the hairline ("No woman wants her hairline raised," he says). Katz talks about the different components of the face—cheeks, neck, mid-face, brow, forehead, eyes—while Dr. Sam Hamra emphasizes that the face has different parts but usually should be operated on as a whole, the "composite face lift."

"The old-fashioned face lifts were achieved by elevating the skin and not what’s underneath," Katz says. "That necessitated pulling fairly hard on the skin, giving you that Barbie doll, windblown look. Today, we’re repositioning the tissues beneath the skin so you don’t have to pull very hard on the skin. Everybody does a different technique, but basically they are variations of the same theme."

Clare Garlick wanted to get rid of the bags under her eyes, the "Jerry Jones look," as she calls it. Her neck was also becoming an issue: "When I put on a turtleneck, my chin touched it," she says. "All the expensive creams in the world weren’t going to change that."

But Katz did change it—without giving her "wind tunnel syndrome," Garlick says.

Hamas performed eyelid surgery and a brow lift on Kathy Flatt two years ago. The 48-year-old says she looked like a basset hound.

"I went in to have my eyelids done, and he suggested that I might want to consider a brow lift in addition to the eyelids," she says. "My dad’s eyes were so baggy that it affected his vision. Dr. Hamas raised my brow and gave me an overall effect of being less droopy, less tired. When your eyelids are baggy, you just feel tired with all that heavy skin. Now I look more rested."

For decades, facial surgery hasn’t changed much. Suddenly, new procedures and technology have updated the popular stand-bys.

"Eyelid surgery has been the same since, oh, 1924," says Hamra, who specializes in face lifts and eye surgery. "You simply took the fat out of the lower eyelids and then smoothed the skin out. Nothing exciting. In the early ’90s, I started looking at my patients and the lower eyelids always seemed to look hollow. I figured out a way to preserve the lower eyelid fat and put it over the bone. This way, instead of looking hollow after surgery, people look very youthful."

In addition to the eyes, Hamra, like many surgeons, rethought the face. "Instead of being a movement backward toward the ear, the face lift should be vertical toward the eye," he says. "On a first-time patient, this prevents the wind-swept look. On a second-time patient (who is having a face lift redo), it can totally correct that look that you associate with Faye Dunaway, Barbara Walters, and Carol Burnett. They all look pretty goofy."

His mission these days is to rid the world of bad face lifts by redoing those he can with more updated procedures. He’s not blaming anyone; he often redoes his own patients 15 years later. The traditional face lift was all they had back then. But now, there is something better.

"Not all standard face lifts look bad in time," he says. "But all face lifts that look bad in time are standard face lifts."

Carmelita Hogan was such a redo. At age 55, she went to another surgeon and had a standard face lift. She was disappointed within a few months. The surgery simply didn’t stick. The surgeon sent her to Hamra and within a year, Hamra performed another face lift. Even after three years, she doesn’t have hollow eyes or a neck that gives away her age.

"Looking young was not the intent," says Hogan, who gives personal development workshops to aspiring models and actors. "I just want to look the very best that I can. And now I do."


Mirror Image: A Guide to Plastic Surgery in Dallas


Everything Short of a Face Lift

Local experts give advice on how to improve the appearance of your skin without surgery.

Spas all over town offer preventive skin care treatments along with low-level repair procedures. At the same time, plastic surgeons are adding skin care treatments to their practices to provide lower-cost alternatives. Before you go under the knife, listen to what some of our local experts have to say.

"Research is teaching us how the skin ages, and doctors are realizing there’s more to anti-aging than just surgery," says Renée Rouleau, owner of the Renée Rouleau Skin Spa in North Dallas. Rouleau divides her treatments into prevention (antioxidants and vitamin C, which prevent free radicals from harming healthy skin cells) and repair (laser resurfacing, Retin-A, microdermabrasion, glycolic, and chemical peels).

Two brand-new skin treatments that fall between laser treatments and microdermabrasion are photorejuvenation ($2,000-$2,500) and non-ablative dermal remodeling ($1,500- $2,000). Dr. Jay Burns, a plastic surgeon who teaches at UT Southwestern, is impressed with the results he’s seen in the last few months with these new treatments. "I don’t think these are going to replace face lifts or laser resurfacing," he says, "but you can get much better results with these than with just skin care and there’s minimal downtime. Patients can go out that night." Both treatments, which require several months to see results, treat crow’s feet, acne scars, and red and brown discoloration. Photorejuvenation, however, can only treat light skin, while non-ablative dermal remodeling can treat all skin colors.

Another option for getting rid of unsightly lines and wrinkles is laser resurfacing ($2,600-$4,200). Burns uses the newest resurfacing tool, the Erbium laser. The procedure causes very little redness and pain, and a patient’s skin is back to normal within a week. But, Burns adds, lasers and face lifts aren’t the only tools available. "It’s nice to be able to offer somebody in her 30s and 40s, who might not be ready for lasers, a microdermabrasion with a light peel," he says. "With these other procedures, it may take a little longer to see an effect, but there is no chance of significant complications."

Chemical peels ($650-$3,400) range from very serious treatments for major sun damage, wrinkles, and acne scars like the TCA (trichloracetic acid peel) to glycolic acid peels that remove dead skin cells.

Pat Riggs, owner of Fascinating Faces in Frisco, is one of the few aestheticians in the country who offers electronic face sculpting ($75-$130). The treatment uses electricity running through pads or a heavy mask into the muscles of your face. Your muscles tingle as the current pulsates through them. Fifteen minutes later, your face looks tighter. "I don’t plan on having plastic surgery on my face if there is an alternative," says Tracie Reveal, a 37-year-old member of the Frisco City Council who went to Riggs mostly for sun damage and skin discoloration. "But I don’t want to look like my dad with big jowls either."

Mirror Image: A Guide to Plastic Surgery in Dallas

Choosing a Doctor

Plastic surgeons offer tips for finding a doctor who’s right for you.

Amazingly, it only takes a medical license to perform plastic surgery. And, with managed care controlling the profits doctors make from procedures covered by insurance, all sorts of doctors are trying to get into the elective treatment game. "With managed care, even ophthalmologists and dentists are doing plastic surgery," warns Dr. Warren Katz. While procedures are relatively safe, they are only so with a qualified plastic surgeon. And as Dr. H. Steve Byrd says, "This has placed a greater burden on patients."

Some tips from plastic surgeons for finding a plastic surgeon:

• Be sure the doctor is board certified by the American Board of Plastic Surgery or the American Board of Facial Plastic and Reconstructive Surgery.

• Look for a doctor who’s not too young and not too old.

• Plastic surgeons are generally quite busy. If yours isn’t, there might be a reason.

• Be sure the doctor has credentials at local hospitals to do the procedure he or she wants to do. While the surgery may be done in the doctor’s office, doctors will still have credentials at hospitals. And hospitals know a doctor’s experience in varying fields. They won’t let a plastic surgeon take out your uterus, and they probably won’t let an OB/GYN put in a breast implant.

• Be sure the person who handles your preop visits is your doctor.—D.M.

No Guts, No Glory

Checking into a medical spa is not for the squeamish. But it’s amazing what we’ll do to improve our bodies.

I am standing on a scale wearing a sports bra and a thong. Beverly Braeshers, co-owner of Somatique, a full-service medical spa, is walking around me, measuring my waist and my thighs. I’m dizzy. I can’t find a focal point. If I look at Beverly, I risk glimpsing a horrifying number from the measuring tape that she is wrapping around my hips. If I look down, I will certainly read the numerical results of my passion for Mexican food on the scale. But I’m afraid to close my eyes, because I’m about to pass out from humiliation.

"Turn around," Beverly orders. I rotate and notice a camera on a tripod. As my hot flash subsides, Beverly positions herself behind the lens and guides me with commands: "Turn sideways."  Click. "Lift your arms." Click. "Now, to the back." Click. I have never felt so fat or unattractive. Until she says, "Now squinch your butt." Click. Click.

To a woman, there are no words more demeaning in the English language.

But I have come to Somatique to wage war on my body. And like boot camp, medical spas aren’t for sissies. There are no dim lights, soothing candles, or Enya. It’s all bright lights and drooping tails.

Microdermabrasion: Not Quite a Face Lift

With the big 50 just around the corner, I decide to look the best I can without depleting what is left in my 401(k). I wouldn’t shy away from a face lift, but medical spas offer lower-cost fixes for sagging eyelids, crow’s feet, and wrinkled lip lines. I sit down with Beverly in a warm-colored room full of weird-looking machines and explore the solutions, from Botox and collagen injections to face lifts. After evaluating the options and my pocketbook, I choose what I call the "working woman’s face lift": two microdermabrasion sessions followed by a comprehensive maintenance regimen of Retin-A and Glyquin—a bargain at $500.

Microdermabrasion is the "it" treatment in local salons. The procedure resurfaces your skin by "sand blasting" the existing layer with a high-powered, crystal-filled canula. To avoid misuse by untrained staff, the machines at most day spas are pre-set at the factory. However, most medical spas are physician-directed and have licensed technicians who can customize the strength and safely erase epidermal layers at varying depths.

After my first treatment, which feels like a cat is licking my face, my sallow skin is rosy pink and the "expression" lines around my mouth are softer. I bump into a friend in the grocery store on the way home and she asks if I’ve been on vacation. After two sessions and two months of using Retin A, the vitamin A-enriched cream some disciples refer to as "youth in a tube," and Glyquin, a cream that slowly bleaches sun spots and freckles to even out your skin color, my skin feels smooth and supple. My foundation is in the trash can.

Procedure Price
Microdermabrasion
Face $200 per session
Face and neck $250 per session
Face, chest, and neck $325 per session

Laser hair removal
Underarms (up to 12 treatments) $500-$2,500
Bikini $500 per hour
Average cost for bikini $4,000

Endermologie
14 sessions $1,400
28 sessions $2,650
Maintenance (once a month) $100

Mirror Image: A Guide to Plastic Surgery in Dallas

Laser Hair Removal: Worth the Pain

If reading about a bikini wax might make you feel faint, then turn the page. Laser hair removal is not a pretty story. But it has a fairy-tale ending: no more shaving or wax jobs.

The good news is laser hair removal is the best thing I’ve ever done for myself. The bad news is it hurts like hell.

I lie on the table—with my arms overhead and my knees bent and spread apart—waiting for the numbing lotion to take effect as sweet Beverly buttons her surgical jacket and covers my hair with a net.

Suddenly I look up to see her standing over me wearing a formidable black miner’s helmet with a halogen light. In her gloved right hand is a gray pistol. For the next half an hour, she "shoots" hot pricks of burning light at every hair follicle along my bikini line and under my arms. There is a faint scent of burning flesh. But when she finishes, all that’s left are little bumps that look like bee stings.


As I get up to dress, she says I did great for my first session. You me