What to expect from plastic surgery.

THERE WAS a time, not many years ago, when most people accepted the faces and bodies Mother Nature had given them. Those of us who faced life with crooked or oversize noses, sagging jowls, puffy eyes and/or body contours that would horrify a fashion director usually had to grin and bear it. Sure, Phyllis Diller could cackle about her latest face lift, and other aging celebrities and wealthy matrons could keep a few plastic surgeons rich. But for the vast majority of us, the idea of getting oneself prettied up via cosmetic surgery was as far-fetched as… well, a monorail on Central Expressway.

Then came the “me” generation of the Seventies, followed by a rapidly increasing emphasis on health and “wellness” in the early Eighties. And suddenly, to project an image of youthful vitality and robust health, a lot of people who would never before have considered cosmetic surgery have found themselves thinking about it. It sounds like a simple, logical alternative to going through life with a face or physique that only a mother could love- but is it really?

Even though such cosmetic surgical procedures as nose jobs, face lifts, breast enlargements and tummy tucks are more popular and commonplace than ever before, cosmetic surgery still is surrounded by considerable anxiety. There are three reasons for this: (1) it is almost always totally elective surgery -in other words, no doctor is likely to tell you that you have to have it done to preserve your physical well-being; (2) it deals with the highly charged emotional subject of how you look (and how you think you look to other people); and (3) it costs a lot of money.

As glowing a picture as has often been painted about the results of cosmetic surgery and the ease with which it can alter one’s appearance for the better, it is vital that the prospective patient take a realistic view toward the surgery and what he/she expects to accomplish from it. Our physical appearance is such an emotional matter, so it’s easy to get carried away. And, unfortunately, there are surgeons who are willing to take advantage of this. It’s not unusual, according to some Dallas plastic surgeons, to see a patient who has gone to a doctor seeking cosmetic correction of one problem and come away with an entire checklist of operations recommended by the surgeon to make the patient physically more attractive and appealing.

This is why anyone seriously considering cosmetic surgery should decide in advance exactly what he/she wants to achieve, what will fit his/her individual needs and what realistically can be expected from what the surgeon has to work with. Don’t, for example, select your new nose or your new face on the basis of a photograph you’ve torn from a magazine and expect a surgeon to duplicate it. If you aren’t realistic about what changes will be feasible for you, most reputable plastic surgeons will be reluctant to do the operation.

Timing is also very important if you’re a candidate for cosmetic surgery. Find out as much as you can about the procedure and the recuperative period after it. Then schedule the surgery for a time when you can relax and give yourself sufficient time for healing and convalescence. Granted, techniques used by plastic surgeons today to reshape nature’s imperfections are highly advanced and, in some cases, can even be considered “miraculous.” Still, remember that surgery is never painless or risk-free and that good results are never instantaneous.

Regardless of what you may have heard or read, any cosmetic surgery is a great deal more serious than a trip to the beauty salon. Once a feature has been altered, it is usually difficult – and sometimes impossible-to reverse the results, even by further surgery. So don’t be taken in by articles or advertisements that would have you believe that resorting to the surgeon’s knife to change your looks is as easy as applying makeup. Before having cosmetic surgery, there are many questions to ponder, many decisions to make.

Why should you seek cosmetic surgery in the first place?

If you expect cosmetic surgery to save your marriage, get you the job you’ve always wanted or recapture your lost youth, then most reliable plastic surgeons will tell you, in so many words, to forget it. Behind that new face or inside that sexy new body is going to be the same old you. If you can’t make it in marriage or employment and if you can’t accept who you are and where you are in life, no amount of surgery is likely to change that. The surgeon’s scalpel is not a magic wand.

The best reason for choosing to have cosmetic surgery is to improve your own self-image. This, in turn, can give you an improved outlook on life, which can help both in your personal and business relationships.

“Cosmetic surgery is often thought of as psychological surgery,” Dr. Harlan Pollock says, “because its purpose is to enhance your feeling of well-being and to foster emotional health.”

If any person is the “perfect patient” for such surgery, Dr. Hamlet T. Newsom says, it is one who understands the procedure, wants it only for himself or herself and is not ashamed of what is being done.

What are the risks?

Anytime a surgeon uses anesthesia or cuts into human tissue, there are risks to the patient. True, the risks are usually minimal, but they do exist. Postoperative bleeding, skin loss, scarring and physical injury are some of the most important problems to consider.

“People see talk shows and read magazines that don’t adequately emphasize the risks or complications,” says Newsom. “I emphasize them a lot. Sometimes it puts a damper on a patient’s enthusiasm, but I would rather have a patient not have the operation because of fear of the complications than to go ahead with the surgery not knowing what might happen.”

What are the available types of operations, the length of convalescence, the possible complications and the approximate cost?

(1) Rhinoplasty, or nose job: This procedure can be done either in the doctor’s office or in the hospital. It usually takes from 45 minutes to an hour and a half, and may require hospitalization for one or two days. It is usually done with a local anesthetic, with the patient unaware of what is happening during the procedure.

Convalescence: Usually, the patient wears a dressing or nose splint for about a week after surgery. There is swelling and bruising around the eyes, which usually disappears in 10 to 14 days. Patients cannot swim for three to four weeks, and no strenuous activity is allowed for two weeks.

Postoperative complications: In about 2 percent of all cases, nosebleeds result.

Cost: $1,500 to $2,500.

(2) Blepharoplasty, or removal of loose skin and fatty protrusions in the eyelids: Almost exclusively a day surgery or office procedure, this operation is often performed in conjunction with face lifts, although the two may be done separately. A blepharoplasty is usually done with a local anesthetic and usually lasts from one to two hours.

Convalescence: Generally, the patient can be up and about in a couple of days with dark glasses, and stitches are removed in four or five days. Under-the-eye bruising subsides in 10 to 14 days, and the patient can often return to work in about a week.

Postoperative complications: Hema-toma, or bleeding under the skin, sometimes occurs. Another extremely rare complication is the pulling away of the lower eyelid from the eyeball as a result of excessive swelling or a technical error during surgery. Subsequent surgery can correct the problem.

Cost: $2,000 to $2,500.

(3) Rhytidoplasty, otherwise known asthe face lift: This procedure has optimumresults if done early in the aging processwhen certain changes begin to occur- thedeepening of creases between nose andmouth, the formation of jowls and theformation of waddle under the chin. Facelifts can be done either in the office orhospital and usually require about three tofour hours. A general or local anestheticmay be used, although most people preferlocal.

Convalescence: Swelling and bruising from this operation last from 10 to 14 days. Most patients are able to resume normal activities within 10 to 12 days and strenuous activities in two or three weeks.

Postoperative complications: Bleeding occurs in 3 to 4 percent of cases. In a very small number of cases, there is skin loss or damage to facial nerves, which can cause paralysis.

Cost: $2,500 to $4,000.

Cost with eye surgery: $4,500 to $6,000.

(4) Breast augmentation: The popularity of this procedure can be traced, in theopinion of one Dallas surgeon, to the factthat “America is a breast-oriented society,” with the size, shape and contour ofthe breast as a major criterion for assessing feminine appeal. Today, a silicone implant filled with jell is the method of breastenlargement used by 95 percent of plasticsurgeons. Two other kinds of implants -an inflatable shell filled with saline solution or an inflatable shell filled with bothsaline and jell -are also used. The operation usually takes about an hour and a halfand may be done as an office or daysurgery procedure under local or generalanesthetic.

Convalescence: Surgeons usually suggest no strenuous activity for about three weeks, but patients can usually resume normal activities within three or four days.

Postoperative complications: The most common side effect is hardening of the breasts, resulting from scar contracture around the surgical incision, the exact cause of which is not known. If such contracture occurs, the tightness of the implant can sometimes be relieved by the application of external pressure. If not, the implant must be taken out, scar tissue released and the implant reinserted. Bleeding occurs in 2 to 3 percent of cases and infection in less than 1 percent.

Cost: $1,400 to $2,800.

(5) Mastoplexy, or breast lift: Usually done during the post-child-bearing years, this procedure is used to correct stretching that occurs during and after pregnancy or extreme weight loss. This repositioning of the breasts can be combined with augmentation. It is always performed in a hospital; the surgery takes about two and a half hours.

Convalescence: About the same as with augmentation, after one to two days of hospitalization. Normal activities can be resumed in a week and strenuous activities in three weeks.

Postoperative complications: Some scarring is a certainty in this procedure, but many patients consider it a good trade for improved breast contour and shape. Bleeding also may result.

Cost: $2,500 to $3,000.

(6) Reduction mammoplasty, or breastreduction: Unlike other plastic surgeryprocedures, this operation is usually donefor medical rather than cosmetic reasons,since women with oversize breasts frequently suffer from neck or back pain.Mammoplasty is always performed in ahospital under a general anesthetic; thesurgery takes from two and a half to threeand a half hours.

Convalescence: The patient stays in the hospital about five days, and vigorous physical activity is restricted for three to four weeks.

Postoperative complications: Bleeding and some nipple loss may result. This operation also leaves scarring in all cases.

Cost: $3,000 to $4,000.

(7) Abdominoplasty, or tummy tuck:This procedure is designed to removeredundant skin and to tighten tissue in theabdominal area. It is always performed ina hospital under a general anesthetic.

Convalescence: Hospitalization lasts from three to five days, and a sense of tightness around the incision is present for about a week, which causes the patient to walk in a stooped-over position. A binder or support worn around the abdomen helps the patient feel more comfortable.

Postoperative complications: This surgery leaves relatively conspicuous scars across the pelvic rim and around the navel. In about 1 percent of cases, bleeding or skin loss may also occur.

Cost: $3,000 to $4,000.

(7) Otoplasty, or ear reduction: Thisprocedure is done to reduce protrusion ofthe ears from the head in either children oradults. Surgeons recommend that it beperformed on children only when the earsbegin to bother the child – not the parents.Surgery is performed under a local anesthetic in the office or the hospital.

Convalescence: Vigorous physical activity is usually restricted for two or three weeks.

Postoperative complications: Bleeding occurs in about 1 percent of all cases.

Cost: $1,200 to $2,000.

(8) Chin augmentation: In this operation, an incision is made either under the chin or lower lip, and a silastic implant is placed in the chin to give it more prominence. Surgery is done under a local anesthetic in either the office or the hospital.

Convalescence: The patient is restricted to a soft diet for five days; swelling may last for one to two weeks.

Postoperative complications: If the incision is made under the chin, there will be an external scar.

Cost: $500 to $1,000.

What are the psychological complications?

Plastic surgeons say that with all the above procedures, the percentage of patients who are happy after the operation is extremely high. However, one possible postoperative complication is the psychological blow of not achieving the desired results.

One way surgeons try to decrease the number of dissatisfied patients is by screening out those people they believe want surgery for the wrong reasons or who don’t actually need the surgery. Usually, a surgeon will attempt to make these determinations during the initial consultation. According to Newsom, about 5 percent of patients decide not to proceed with the operation after consultation.

To evaluate his patients, Dr. Mark Lemmon uses a conversation-distance test. “If the person has a complaint and it can be seen at conversation distance, I tell him surgery will probably improve it,” he says. “If a patient doesn’t like something about himself and I can’t see it, he usually will be unhappy with the results. I tell patients they can find someone to operate on this type of problem, but they run the risk of being unhappy because it can’t be corrected by surgery.”

That is not to say, however, that minor deformities in attractive individuals cannot be corrected by cosmetic surgery. “Such cosmetic corrections can make a major improvement in appearance,” says Lemmon, “and may vastly improve the self-image.”

Spending a lot of time with the patient beforehand and offering careful explanations of the problem and the procedure is one of the best ways to insure a happy result, most surgeons say. “The surgeon should tell the patient all he can,” says Pollock. “He needs to make sure the person understands all aspects of the surgery.”

Another reason for negative results is what Lemmon calls “the overoperated patient.” “If you take a woman who has been looking at her nose in the mirror for 50 years and make it too little, for example, extreme depression can result. The greatest anxiety patients have is to end up looking ’too different’ after a face lift or some other operation. The realistic patient wants improvement – not drastic change.”

Will insurance cover the surgery?

Probably not. Cosmetic surgery is excluded by most health insurance policies, unless it simultaneously corrects a medical or functional problem. Thus, prepayment of fees is the usual practice. Sometimes a secondary procedure is required for a touch-up, revision of scars or a complication. Before the initial operation, you should ask your surgeon to explain his policy on the charges for any secondary procedures that might be needed with your. operation.

How do you choose a plastic surgeon?

Beware of doctors who don’t spend a lotof time explaining the factors involved inthe surgery or who seem to be trying to sellyou on additional procedures beyond theones in which you have expressed interestor who dissuade you from seeking a second opinion. Also steer clear of those whopromise bargain fees or miraculous makeovers or who promise to obtain insurancebenefits for operations not normallycovered by insurance. ,

Cosmetic surgery falls within the spe-cialty of plastic surgery, and most plastic surgeons are certified by the American Board of Plastic and Reconstructive Surgery. But, as one Dallas surgeon points out, some 10 percent of the approximately 40 doctors listed under the “plastic surgeons” heading in the Yellow Pages do not have this certification.

Other guidelines to use in selecting a surgeon:

-Examine credentials, training andhospital affiliations.

-Check with the Dallas County Medical Society.

-Ask the advice of an internist, gynecologist or family physician.

-Always seek a second opinion and askeach physician for at least two references.”It’s worth the extra consultation fee,”says one surgeon, “to find a doctor who’sright for you.”

ONCE YOU’VE signed up for the operation, you’ve placed your total faith in the surgeon you’ve selected. Your face, your figure, your physical and psychological health are all at stake -so use care.

And be informed, both about the surgery you are contemplating and the personyou choose to perform it. If you are, cosmetic surgery can be a legitimate route to ahappier and more satisfying life. But ifyou aren’t, it could be a ticket to something much worse than a flawed face or aflat figure.


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