we’re so VAIN

When it comes to physical perfection, all is vanity and all is definitely not fair. But if you weren’t born with it, buy it-everyone else is.

Surgically altered celebrity prof iles are increasing in number as rapidly as Cher’s tattoos-which isn’t news to anyone who has glanced through People magazine recently. But what is news is the refreshing frankness these famous folk exhibit about their plastic surgeries. Beginning with Betty Ford’s facelift and ending with fane Fonda’s new breasts and Ivana’s new everything Americans are witnessing a different attitude about cosmetic surgery. The taboo has been lifted. Now plastic surgery is just another item on the long shopping list toward perfection. But you don ’t have to make your living with your looks to want to change them. Real people, like you and me, are lining up in droves to be nipped and tucked and stretched and tightened. We no longer consider it “unnatural ’ ’to buy what we weren ’t born with or to turn back the hands of time. For now at least, Mother Nature has taken a vacation, and “Everyman” is having a nose job.

in fact, as the Me Generation grows older, plastic surgery has practically become a national pastime. The American Society of Plastic and Reconstructive Surgery reports that operations performed by its members rose 63 percent during the Eighties. Accord-inglo U.S. News & World Report (May 1, 1989), 39,000 facelifts were performed in 1981; in 1989. 75,000 were done. Liposuction (pronounced lipe, not lip), still a fairly new procedure, is also the most popular-250,000 were performed in 1989 by board-certified surgeons, and all kinds of doctors, from gynecologists to otolaryngologists, are learning the lucrative technique. While there are no statistics compiled on the number of surgeries performed locally, Dr. Robert Hamas, president of the Dallas Society of Plastic Surgeons, says “overall, plastic surgery in Dallas is absolutely on the rise, and it’s no longer just real estate tycoons and their wives-now it’s teachers, secretaries, and policemen.”

Perhaps part of the trend can be attributed to our aging population-obstetricians were busy in the Fifties; plastic surgeons will be busy in the Nineties. But it’s not just that more of us are getting older-there’s something psychological going on here as well. We’ve raised a generation of baby boomers who are used to having it all, and now we’re watching that acquisitive instinct kick into high gear. Once you have the perfect home, the perfect car, the perfect wardrobe, what else is there? If you can have the perfect body, then why not?

For some, plastic surgery is a way to fool Mother Nature-to circumvent physical aging, at least in appearance. Or, for those who have jogged, cycled, and aerobicized themselves into fitness, it promises the final solution to the shape they’ve been sweating toward. Plastic surgery also provides an emotional boost. Gone is the perceived physical flaw; in its place is newfound self-esteem.

“There’s no such thing as natural beauty,” says Truvy, the beautician in Steel Magnolias. She dealt in hair dye and perms, but the line between fiberglass-augmented fingernails and silicone-augmented breasts seems an arbitrary one. Dr. Sam Hamra, one of the top aesthetic plastic surgeons in Dallas, feels that “plastic surgery is just part of the natural human desire to be attractive. People have worn wigs, contacts, braces, and shoulder pads-why are these any more natural than a facelift?” Well, because scalpels are riskier than Velcro, and, as one rhinoplasty patient remarks, “Anyone with a brain is going to have a normal fear of surgery. And, I won’t lie. It hurts.” Still, discomfort for beauty is an ancient trade-off, and with current techniques, plastic surgery is less painful and more effective than ever before.

“Plastic surgery has been stigmatized as being selfish,” says surgeon Dr. John Tebbetts. “Now people see it not as an act of vanity, but of self-esteem-a very healthy thing. In fact, this is one of the few things that should be totally selfishly motivated; you should have your nose or your breasts done because of how you feel about it, not because of how someone else may react.”

“I did this just for me,” says Debbie, a forty-seven-year-old commercial artist who had her eyes done. “My lower eyelids were puffy and my upper ones were droopy-it’s hereditary, just like the hump in my nose. But my nose never bothered me and my eyes did. For me, it was totally a personal decision.”

As Hamra points out, “Today people live so much longer. They have developed minds, they’re healthy-why not look as good as you feel? That’s not egotistical or worshiping at the altar of youth.”

Speaking of the altar of youth, one of the biggest changes in plastic surgery is in the demographics; now patients of all ages are dabbling in the reconstructive arts. And, as the general attitude toward plastic surgery has become more permissive, more men are having it done-eyelid tucks, scalp reductions, hair transplants; procedures that can quickly subtract a good ten years from a middle-aged chassis.

Technological advances have made most of these popular procedures easier, more effective, longer-lasting, and more precise. But some of the new techniques, like fat injections, are the result of unfortunate mistakes. One of the real risks of liposuction is the removal of too much fat by an inexperienced or untrained doctor. One solution is to reinject the suctioned fat into the sunken area, or “recycle” it to other parts of the body-to fill in lines in the face, for instance. Though the results aren’t permanent, some doctors predict that the technique may replace collagen injections.

Cosmetic surgery is a lucrative business, so it’s no surprise that more and more new doctors are choosing to specialize in plastic surgery, and many established doctors are adding cosmetic procedures to their practices. To add to the confusion, in Texas, any doctor can legally call himself a plastic or cosmetic surgeon; with so many to choose from, it’s very difficult for a patient to select a qualified doctor. Most doctors claim some kind of “board certification,” but the boards vary widely in their requirements. Only one, the American Board of Plastic Surgery, is recognized by the American Board of Medical Specialties. Certification by this board at least guarantees that the doctor has completed a residency in general surgery and a separate plastic surgery residency, as well as passing rigorous oral and written tests.

Cosmetic surgery may have become fashionable, but “’the equation of surgery with fashion is misleading,” cautions Tebbetts. “You’re considering permanent medical procedures.”

In other words, impulse shopping is out of the question. “I shopped two and a half years for a plastic surgeon,” Joan recounts. “I didn’t know anything about it when I started. It’s sort of like trying on a wedding dress. You don’t look for one until you’re ready to buy one.” The Dallas Society of Plastic Surgeons and the American Society for Aesthetic & Plastic Surgery both require ABPS certification for membership, so that is a good place to start shopping; the American Society of Plastic and Reconstructive Surgeons also requires certification. The ASPRS has a toll-free plastic surgeon referral service. Call 1-800-635-0635 to request a list of certified doctors in your area; you can also call for verification of a physician’s ABPS certification.

Unfortunately, even certified surgeons agree that certification alone is not enough to go on. ’The training mainly gives you a healthy respect for things-it makes you aware of the limits of your knowledge,” Tebbetts says. “There’s still a wide range of expertise among certified surgeons.”

“The best thing to do,” advises Hamas, “is to ask lots of questions. Interview several doctors. Use common sense. The extent of a surgeon’s experience is at least as important as his certification. Does the doctor perform office surgery? If so, does a CRNA (certified registered nurse anesthetist) or a nurse administer the anesthesia? Is the office an accredited facility? Even if the doctor uses an office operating room, it’s good to know whether he has privileges at a major hospital to perform the operation you’re interested in-it indicates his standing among his peers.”

Regardless of standing, however, even qualified surgeons make mistakes. “The difference between a good plastic surgeon and an excellent one is that the excellent doctor has better aesthetic values and judgment,” says Dr. Jack Gunter, a rhinoplast specialist. While extremely important, those are hard qualities to measure.

“’My first nose surgery was awful-it totally messed up my nose,” recalls a thirty-five-year-old Dallas woman. “He had great qualifications, but bad hands, I guess. It ended up crooked, with a dent on one side and a big ball on the end. I was badly bruised and swollen for two months; by six months the doctor was talking about filling in the sunken place with collagen, and I started looking for another surgeon.” Her second rhinoplasty, also with a certified doctor, was a success. “I even felt better coming out of surgery. I went out to lunch with my husband ten days later. I have a gorgeous nose. The first doctor kept telling me I shouldn’t change my nose-that it should be aquiline to go with my face. I felt completely comfortable with my second surgeon.”

Which brings us to the really tricky part about aesthetic surgery. “Success is subjective,” says Tebbetts flatly. “It’s not like a gall bladder operation-you remove the organ, the patient lives; clearly the operation was a success.”

“How success is rated is very personal,” says Hamra. “Sometimes patients don’t know what all their options are.” He cites the example of a woman who came to him for a rhinoplasty. “She wanted to reduce the size of her nose, and her nose did need some shaping. But to give her the profile she really wanted, she also needed a chin implant.”

“It’s part of a plastic surgeon’s job to give a complete facial evaluation, not just perform the requested surgery, The patient may have pinpointed the problem that bothers them the most, but they aren’t aware of the complete situation,” explains Gunter. On the other hand, as in Debbie’s case, the patient may love the irregularity of her nose and only be bothered by a single problem.

“The endpoint of plastic surgery is always between the ears,” says Hamas. “We operate on the body, but the real results are in the emotions. That’s why it’s so important to work with a doctor who’s not only qualified and has lots of experience, but is someone you feel comfortable with, someone you can communicate with. You’re going to see this person’s opinions in your mirror for a long time-you’d better agree.”

TRUE STORIES

Beverly, age 42, graduate student Liposuction, upper thighs

“What I had was just deformed-looking saddlebags. I was a size 8 on top and a size 12 on the bottom. 1 was working out at a gym at least five times a week, and even when I starved myself down to 118 pounds, I’d look like a skeleton on top and still have fat thighs on the bottom.

“The process is really gross, and it hurts. I went back a second time and had him shape the contours a little while 1 was standing up-I don’t think you get a real picture of your body shape lying on a table.”

Jack, age 32, small business owner Nose job and chin implant

“1 was sick and tired of being described as the ’guy with the nose,’ so I had it fixed when I was twenty-nine. The doctor talked me into a chin implant, but, though I’m pleased with the nose job, my chin still looks weak. I guess I’m stuck with this beard.”

Julie, age 39, homemaker and mother of three Breast implants

“After each of my children, as soon as I lost the weight I’d gained, my breasts were smaller, too. I went from a 34C to a not-filled-out 34B. I was sick of looking at empty darts in my dresses.

“My suggestion to anyone who does this is to pick a size of implants you like and go down one size; that’s what I did, and I think they look perfect.”

Sharon, age 44, graphic artist Eyelid tuck

“You know how, when you look in the mirror, there’s always one thing that stands out? Well, that’s the way I was about the bags under my eyes for the last ten years. I can’t look at them objectively, even now. The doctor pointed out that my upper eyelids were puffy, too, so I had both done. The process was much easier than I expected it to be. I only took the pain pills once.”

THE FACE



The face is the first part of your body to show signs of age, so obviously it gets a lot of attention from plastic surgeons. “The late thirties and forties are big milestones for most women,” says Hamra. No kidding. These are the years when you discover that all those innocent little lines have banded together to make big crevices, and that no amount of sleep will get rid of the bags under your eyes. Some may call it character. Others call Hamra instead.

A facelift used to last two or three years. But, in a new procedure developed by Hamra, called a deep-plane rhytidectomy, the fat as well as the skin and muscle of the cheeks is tightened, smoothing out the lines running from the corners of the nose to the mouth, which used to be left unimproved. The results last much longer than older techniques. Some plastic surgeons, including Hamra and Tebbetts, now perform a browlift along with a facelift for a more complete restoration. Tebbetts calls the browlift “one of the best operations we do.” It smooths out the lines in the forehead, lifts the upper eyelids, and generally opens up the upper half of the face. Hamra’s philosophy is “it all aged together, so it should be changed together.” But a browlift is more than a subtle, “rested” look; it’s a definite, frank alteration that can’t be missed.

But with the new, open attitudes toward plastic surgery, patients are more often pleased with extreme changes. They’re not as anxious about people noticing the surgery they just spent thousands on. “Younger patients, who have been changing all their lives, adapt better to strong changes in their appearance,” says Gunter.

When it comes to facial plastic surgery, there are a number of procedures to choose from. If you plan to have more than one procedure done, it’s probably best to have the same surgeon perform them. Among the most common:

FACE AND NECK SURGERY (RHYTIDECTOMY): The classic facelift, this is performed to remove loose, sagging skin from the face and neck. (Remember, eyelid surgery is separate.) This procedure may be done under a local anesthetic, although many doctors prefer to use a general. The incision usually starts in the hairline, curves around the ear, and extends toward the back of the head; the operation is done first on one side of the face, then the other. The skin and fat are pulled up and back, the excess is removed, and the incisions closed. The average recovery time is about three weeks; average cost in Dallas is about $9,000.

EYELID TUCK (BLEPHAROPLASTY): The skin around the eyes is delicate; this is typically one of the first areas patients want corrected, usually in their forties. Incisions in the upper and lower eyelids follow natural creases; extra fat and baggy skin are removed . Occasionally, a browlift may replace an upper eyelid tuck. Sutures are removed within a week; bruising and swelling subside in about six weeks. The average cost in Dallas is about $3,000.

NOSE SHAPING (RHINOPLASTY): This is done to clear blocked airways as often as it is done for cosmetic reasons; often the motivations are combined. The surgeon may be a certified plastic surgeon or otolaryngologist-the best are both. First rhinoplasties are usually done through an internal incision. Splints, packing, or tubes are removed within a week or so, and bruising usually disappears in a few days, but there may be some swelling for months. The final appearance of the nose may not be evident for six months to a year. The average cost for a fairly simple nose job in Dallas is $3,500.

BROWLIFT: An increasingly popular operation that tightens the forehead, smoothing out lines and repositioning the eyebrows, often making the eyes appear larger. The average cost in Dallas is $3,800.

COLLAGEN INJECTIONS: Natural protein derived from bovine cartilage, collagen is injected just under the skin to plump out vertical lines around the mouth, smooth out acne pits, or erase creases between the eyes. Recently this procedure has been used by models and actresses to plump up their lips. The effect only lasts three to six months, but can be repeated. Costs vary widely, depending on the extent of treatment. The average cost in Dallas-from $150 to $500.

CHIN RESHAPING (GENIOPLASTY): If the problem is more than cosmetic-if it affects the bite, or chewing or speaking properly- the plastic surgeon should consult with an orthodontist. Extreme problems involve altering the bone structure; most commonly, an implant is slipped into a pocket between the chin bone and the muscle. The cost varies widely-from about $1,000 to $3,000.

By the way, unless there is a clear medical reason for plastic surgery, such as breast reduction for back pain, blepharoplasty for impaired vision, or rhinoplasty for breathing difficulties, you’re on your own when it comes to paying for plastic procedures. So lots of doctors now take credit cards and offer payment plans, taking up the slack where insurance companies leave off. The usual requirement of payment up front used to rule out cosmetic surgery for credit-crazy Americans who are used to financing discretionary purchases. To make it easier, the ASPRS has introduced a financing program that member physicians can make available to their patients. We didn’t pay cash for the house and the car; why should a facelift be any different? Cut now. Pay later.



THE SMILE

“It’s strange to me that so many people will spend thousands of dollars on a facelift and never consider the most important feature-their smile,” says James Martin, a Dallas specialist in cosmetic dentistry. But take a look at the Yellow Pages-it’s clear from those flashy ads that much of dentistry’s focus has shifted from health to cosmetics. Dental groups call themselves “smile centers,” promising the patient no pain, a beautiful smile, and easy payment. There’s a lot more to pretty teeth these days than brushing after every meal and having regular check-ups-you can reshape, respace, rebuild, and even change the color of your teeth.

DIRECT BONDING: Originally developed as an alternative to capping, bonding’s major advantage is that much of the original tooth can be retained. A composite resin is applied directly to the tooth, then sculpted, set, and polished. Bonding should last from five to ten years if properly done. Martin calls it “the most technique-sensitive procedure dentists do. It really requires artistry.” He suggests that you ask to see photographs of the dentist’s work; albums of before-and-after shots are actually provided by dental supply companies. The cost is $150 to $300 per tooth.

PORCELAIN VENEERS: These are manufactured by a lab according to yourdentist’s specifications, so they’re less subject to his skill. Porcelain veneers last longer than bonding, but are more costly at the outset. Martin uses them sometimes “if your teeth don’t show enough when you smile.” He encourages patients to bring in a photo of a smile they like, but points out that Farrah Fawcett shows fourteen teeth when she smiles. “It’s a little much, really.” Cost: $400 to $700 per tooth.

BLEACHING: This is especially good for tetracycline-stained teeth or for ex-smokers or coffee drinkers. In the past, strong hydrogen peroxide solutions were applied to the teeth, which were then subjected to light and heat. It sometimes took seven to ten visits to achieve dubious results, and 80 percent of the patients experienced some short-term sensitivity to the solution. Then White & Brite came out with an at-home system, which took about a month to work. The latest in tooth bleach, Opalescence, takes four days instead of four weeks. The dentist makes a plastic appliance to fit your teeth; the appliance is filled with a sticky gel and worn for eight to ten hours a day, The cost for White & Bright is $300 for one arch; $500 for both. Opalescence is $400 for one arch; $600 for both.

Choosing a cosmetic dentist can be almost as confusing as choosing a plastic surgeon. The American Dental Association doesn’t recognize cosmetics as a specialty, but you might check for the following qualifications: is the dentist a member of the American Academy of Aesthetic Dentistry or a Fellow of the Academy of General Dentistry? Referral and consultation are equally important clues, and don’t forget to ask to see photos of the dentist’s work.



THE HAIR



Men, too, are tempted to turn back the hands of time, but, for the most part, their concern is not so much the aging face as the thinning hair. Most men (60 percent) experience some hair loss as they age, usually because of genetic male pattern balding. Some drugs have proven helpful, but the most effective remedy right now is hair transplantation, according to Dr. Dowling Stough of the Baylor Hair Research and Treatment Center, Stough harvests circular grafts from a single area along the back of the head (which is usually unaffected by male pattern baldness). The harvested area is closed, using plastic surgery technique, so that only a thin scar remains. The round grafts are trimmed into quarter-grafts and micro-grafts, some containing a single hair. Stough uses a local anesthetic and plants the hair in “slit grafts” all over the balding area. The tiny individual incisions allow him to place the hair according to its natural growth direction, and to feather it out at the hairline, avoiding the clumpy, doll-like spacing seen in traditionally transplanted hair. A scalp reduction (the removal of skin from the balding area) is often done along with transplants; the resulting scar is later filled in with grafts. “I usually plant 150 to 200 grafts at each session; it takes at least three sessions to complete most patients, and we wait three months between each one. The hair falls out at first, but in six months you can really see the growth.”

Patients come in the day after surgery for a shampoo and blow-dry, and most of them return to work the next day. Transplants are $1,800 per session, and most men require three or four sessions.



THE BODY



“I’d been thinking about it ever since I heard about it,” says Tom Agnew, co-owner of the popular restaurant, Cafe Margaux. “And I’d do it again in a second. No matter how much 1 worked out and watched my diet, there was a small spare tire that I couldn’t get rid of. One morning, I just said, that’s it. I’m going to do it.”

The appeal of liposuction is a large part of what has fueled the plastic surgery boom. With the advent of this relatively simple technique, people who had never dreamed of having plastic surgery suddenly realized they could actually change the shape of their bodies. Large portions of their bodies. So-called hereditary rat deposits became inconsequential globules in the face of modern medical technology.

SUCTION-ASSISTED LIPECTOMY: Today, this procedure is less invasive than it was in its early days, as doctors use only small incisions in which to insert a thin cannula under the skin. The can-nula is attached to a suction unit and the extra fat is vacuumed out. This is not an alternative to dieting and exercising fat away; the best candidates for liposuction are actually young and healthy, and of approximately normal weight.

Liposuction is used most effectively on thighs, hips, buttocks, and abdomen; it is not as effective on knees, ankles, and arms, according to surgeon Dr. Diane Gibby. because there is a single fat layer in these areas and because you’re working closer to underlying “architectural” elements like bone and tendon. To avoid “rippling” of the skin, Gibby says it’s best for the surgeon to approach the target area from two angles, leaving a thin layer of fat just under the skin. Usually the surgeon removes two liters of fat; if more removal than that is necessary, she suggests doing it in stages. Liposuction can be performed under local or general anesthesia. A snug, girdle-like bandage is worn for two to six weeks; swelling and bruising should subside in two to four weeks. The costs for this surgery vary according to how great an area is to be treated, whether the operation is performed in a hospital or office, and, of course, who does it, but in Dallas the prices range from $2,000 to $4,000.

TUMMY TUCK (ABDOMINOPLASTY): This procedure is like a facelift for the abdomen-the loose skin and fat, often caused by loss of elasticity in older patients or multiple pregnancies, is detached, stretched, and the excess is cut away. Usually incisions are made across the pubic area and around the umbilicus. This is almost always an overnight hospital procedure. A supportive girdie may be worn for up to two or three weeks. The average cost in Dallas is $4,600.

breast augmentation: “Breast augmentation,” says Teb-betts, “used to be simply a matter of volume. We now have the capability of shaping a more proportionate, natural-looking breast over a greater size range.” Implants now come in a selection of sizes and materials. The traditional, smooth silicone implants pose a greater risk of “capsular contracture,” a condition in which the tissue tightens around the implant, leaving the breast unnaturally hard. New textured implants made of polyurethane or, newer still, silicone, are filled with the usual silicone gel, but have a fuzzy surface that prohibits the surrounding cells from “locking” around the implant and hardening. Currently, researchers are trying to come up with a biocompatible filler, like peanut or sunflower oil, that will be transparent on a mammogram. Breast augmentation surgery is usually performed under general anesthesia; the costs in Dallas range from $3,700 to $5,000.

breast reduction: This particular surgery is more complicated than augmentation. The areola (the dark area around thenipple) must be moved and extra fat and skin removed. It is alsomore expensive-the average cost is $4,800-but it is oftencovered by insurance.

THE ULTIMATE HIDEAWAY

Even with all of our new attitudes about plastic surgery,”it’s a very vulnerable time,” says Peggy Byrne. The overwhelming majority of cosmetic surgery is done on an outpatient basis, which can leave patients in an uncomfortablesituation at the end of the day, as Byrne found out when sheunderwent her own reconstructive surgery. With partner Lynda Pass, Byrne turned a problem into a lucrative business byopening the Hideaway last June. Located in the Guest Lodgeat the Aerobics Center, the Hideaway is a recuperative retreatexclusively for cosmetic surgery patients-the first of its kindin Dallas, though there are similar facilities in Phoenix andBeverly Hills. “It’s not a medical necessity; these peopledon’t have to be in a hospital,” says Byrne. “It’s an extensionof the luxury. Some of them have come from out of town, orthey simply want to rest, away from work and family pressures, or they want their surgery to be confidential.” Something of a cross between the Greenhouse and Parkland, theHideaway offers limo service to and from your surgery, lotsof pampering-goosedown pillows and duvets, VCRs, breakfast in bed-as well as complete discretion, and, if you like,a nurse on call twenty-four hours a day. All for the approximate price of a room at The Mansion. -M.B.M.

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