Beauty FOR SALE

THE CORK POPPED OFF THE CHAM-pagne bottle, and the pretty woman poured. Katsy Gracey sipped the bubbles, took a bite of the smoked salmon, and relaxed. Despite the heavy LBJ traffic and the hassle of getting here right after work, Dr. Gregory Stagnone’s “Stag” party was going well, very well. Fourteen women plus the secretaries, great food, and they’d soon be hearing from the man who had the power to change whatever they didn’t like about themselves.

Some were draped across the elegant chairs of his office waiting room; others sat on the floor sipping champagne and emitting that nervous charm some women radiate when in the presence of a tall, impeccably dressed man. Stagnone, a Dallas plastic surgeon, began his presentation of the latest surgical techniques: tumescent liposuction to sculpt bodies; lasers to vaporize wrinkles and zap broken veins; breast augmentation to achieve perkier breasts; rhinoplasty to shape noses more perfectly than nature did. Later, he told the ladies, everyone could get a personal consultation on his state-of-the-art computer imaging system, Their photos would be displayed on a computer monitor and the doctor would demonstrate the surgical changes under consideration right there on the screen, like a Spielberg production. It would almost be like trying on a face lift or a nose job or liposuction.

“I’m telling you, you’re gonna love it,’’ says Katsy. A petite and energetic district manager for Lynden Airfreight, Katsy helped Stagnone’s office staff arrange the plastic surgery party because she is a most satisfied customer. Though she’s barely past 30, Stagnone has enhanced her breasts, chiseled her nose, and trimmed her stomach, hips, and thighs. Two months after her last procedure, Katsy has become a “deputy” for Stagnone.

“I liked what he did for me, so we talked about getting a few people together for the computer imaging and to have him answer a few questions,” says Katsy. “My friends knew a few friends and before you knew it, we were having a plastic surgery party.”

Before the night was over, everyone had their computer imaging. All 14 women booked consultation appointments. One of Stagnone’s office assistants even had her lips injected for a fuller, poutier look.

“She looked great,” says Katsy. “Said it didn’t hurt at all. At least two girls at the party have already had their lipo and breast implant surgery and I know more will, as soon as they can get together some money. We’re definitely going to have some more parties.”

Parties, patient education seminars, computer imaging at bridal fairs, and “deputizing” patients-this plus a heavy dose of public relations and advertising in magazines and newspapers and on radio and television; the good doctors want our bodies. Some offer discounts on breast implants on holidays such as Valentines Day. There are even interstate price wars: One Oklahoma City doctor, not a board-certified plastic surgeon, offers bargain breast implants for $1,800, several thousand below the average price in Dallas-$4,500.

“Plastic surgery is a hot commodity,” says Greg Washington, owner of Los Angelesbased Patients Unlimited, an international marketing firm for discretionary-income physicians, those such as plastic surgeons whose incomes depend not on insurance reimbursements but on cash. “The baby boomers are putting a lot of money into themselves.”

Used to be, says Washington, all a doctor had to do was a decent job of operating and marketing his practice internally, turning happy outcomes into recommendations. Now the heat is on for the newcomers. Specialists with incomes nicked by managed-care costs and treatment controls are dabbling in the discretionary specialties, like plastic surgery. Both plastic surgeons and facial plastic surgeons (otolaryngologists [ENTs] or head and neck surgeons) are bristling as “specialists” fresh from weekend courses invade their turf-ophthalmologists doing eye lifts, dermatologists lasering skin.

“The technology explosion is really erasing the line of demarcation,” says Washington. “The laser companies, for example, are selling to a variety of specialists. And they advertise, promote.”

So would the real plastic surgeon please stand up? “If you’re good in this city, you don’t need a PR person,” says Dr. Jack Gunter.

But a young surgeon who wants business (wants to eat, as Dr. Sam Hamra says} has to do more these days than put an ad in [he Yellow Pages, do trauma cases in the ER, and pray for referrals. Merely being a good surgeon may not be enough.

“The cream flows to the top,” says Dr. Bill Carpenter, who just merged his three-year practice with that of Dr. Paul Pin. “1 think solid training and word-of-mouth are the best referrals. But to get a piece of the pie, maybe an ad would help get our message across.”

Stagnone, a 39-year-old Albuquerque native, started practicing at Lake Pointe Medical Center in Rockwall five years ago; he’s now in both Dallas and Rockwall, and he never stops hustling for business. He and his computer imaging specialist spent eight hours at a spring bridal show doing free imaging for prospective brides. The line at his booth was longer than both the Victoria’s Secret and the bridal gown lines; every blushing bride-most in their 20s and early 30s-wanted to see what she would look like with a little nip here, a little tuck there. Stagnone’s marketing apparently works: Both he and Carpenter figure they’re doing 10 to 15 cases per week, including reconstructive procedures. Not bad for newcomers, says Greg Washington: Most plastic surgeons do 400 to .500 aesthetic surgeries per year. Well established plastic surgeons, like Fritz Barton, Jack Gunter, Sam Hamra, Scott W. Harris, Warren Katz, G. Hunt Neurohr, and others, are booked solid for months in advance.

We’re So Vain

IT USED TO BE THAT WOMEN SPENT MONEY on make-up and clothes to feel younger and prettier. Today, women have found chat youth and beauty are more than skin deep, and may require shortening the muscles below the facial tissue for a long-lasting face lift, or an entire facial rejuvenation with cheek implants and CO2 laser resurfacing down to the shrinking collagen. Plastic surgery is hot-a business taking in more than S1 billion every year, according to the American Academy of Facial Plastic and Reconstructive Surgery.

The most popular procedure in Texas and in the United States is the chemical peel, usually on the face. First runner-up is liposuction, or vacuuming fat bulges for body sculpting: 3,407 Texas bodies were sucked in 1994. Next popular is eyelid surgery-goodbye baggy eyes for 3,311 folks. Then comes breast implant removal. Ten years ago, women couldn’t get breast implants fast enough-one now-retired North Dallas plastic surgeon, whose surname begins with a T, had his nurses wearing T-shirts with the slogan, “Tits by T “; but in 1994, 3,236 Texas women wanted silicone implants out or exchanged for saline. About 2,500 had first-time breast augmentations with saline-filled implants. And more than 2,700 Texans altered the shape of their noses in ’94.

Plastic surgery patients are also getting younger. More women in their late-20s and mid-30s are succumbing to the endoscope, scalpel, laser, or suction cannula to perfect what they have or change what they never liked. The average plastic surgery patient now is between 35 and 50, according to the American Society of Plastic and Reconstructive Surgeons.

They are not necessarily wealthy, either. Teachers, secretaries, writers, and average working women want to turn back time as much as socialites and stars do. Most save their pennies, but financing is available. Texas Commerce Bank, for one, offers qualified financing to patients at reduced interest rates. Transamerica Finance Corporation has a finance program, and even Mentor, maker of saline breast implants, offers patient financing. So by their first face lift at 50, many women already have had breast implants, liposuction, maybe a nose job, peel, or brow lift. It can all be done for about $ 14,000-less expensive than many cars, fully financed.

“I look totally different,” says Maria Vowell, 34, who’s bad her nose fixed, her brow lifted, her breasts augmented, and her body liposuc-tioned by Dr. Robert Hamas. “My life has completely changed. I got plastic surgery, got a divorce, and now everyone at work wants to go out with me.”

“I’m 44 and still hunting for a partner,” says one attractive secretary who has had breast, brow, nose, and lipo work. “I can’t afford not to look good.”

Katsy Gracey was already married and employed when she had her surgeries. She says she wanted to maintain her “Baywatch” figure and stay ahead of the attractive young competition in her field.

“There are already 24-year-olds out there, fresh and full of vitality,” she says, “Why not use every option available?”

Despite the marketing tactics, turf wars, and the competition for patients, this still may be die best time in the history of the world to be a plastic surgeon.

The Plastics Capital

WHEN IT COMES TO AESTHETIC SURGERY, DALLAS STANDS CHEEK-TO-cheek with L.A. and New York City; we may even be better. There were 28,690 plastic surgery procedures performed in Texas alone in 1994, almost 8 percent of all procedures done in the United States. (That does not count procedures by cosmetic plastic surgeon diplomates of the American Board of Facial Plastic and Reconstructive Surgery.) Texas, along with California, Florida, and New York, boasts the highest overall percentages of plastic surgeons among the 50 states. By many measures, Dallas is the strongest plastic surgery teaching center in the country. No other city can boast such a high concentration of peer-esteemed, internationally respected plastic surgeons who teach, publish, invent new techniques, and practice. As one doctor says, every time he attends a plastic surgery conference, someone from Dallas is there teaching. There are more educational programs presented for plastic surgeons in our city, and more techniques taught here than anywhere else in the country, says Dr. Rod Rohrich, chairman and professor of the Division of Plastic Surgery at the University of Texas Southwestern Medical Center. Not only is Southwestern s plastics residency extremely competitive, it churns out a fair number of surgeons each year.

“Four per year,” says Rohrich, “just like NYU and UCLA. That’s more grads than at any other plastic surgery residency program.”

People fly in from around the world to have face lifts, rhinoplasties (nose jobs), breast augmentations, and now laser resurfacing in Dallas. Even Hollywood comes to us looking for beautification; Warren Katz has worked on Phyllis Diller. Many surgeons on both coasts have learned new procedures right here.

“Friends tell their patient, ’my buddy in Dallas will take the stitches out at home so you don’t have to fly back,’ ” says Dr. H. Steve Byrd. “It turns out I trained the surgeon here in Dallas on the procedure someone flew out to Los Angeles to get.”



Make Me Gorgeous-Again and Again

DR. SAM HAMRA, KING OF THE FACE LIFT, IS GOING THROUGH THE mail in his penthouse office across from Baylor. He has lightened, tucked, pulled, and tightened hundreds of faces.

“This happens every day” he says. “Look at this woman from L. A.- she’s beautiful. She wants plastic surgery.”

Why did she need a plastic surgeon? A successful actress on television a few years ago, she had lost (she wrote) her husband, career, and more than $40 million. She enclosed several current photos taken sans make-up-a far ay from the promotion photo. Nothing like a divorce and bankruptcy to give gravity a jump-start. She had heard Hamra was the best man for restoring beauty to women who had lost it all-their trim chins, their elegant cheeks-and were now stuck with those terrible, dark-lidded, hollow eyes.

“But she is still beautiful,” he insists. “She just needs a little help.”

Tall and dapper, Hamra bears a handsome similarity to Sean Connery. “This is what happens about age 35,40-the fat under the eye shifts and die muscles loosen,” he says, pointing to the photograph. “You begin to see more of the cheekbone, that hollow look.”

What’s the liFe-span of a good face lift? Usually 10 to 15 years, sometimes more. The aging process depends, of course, on heredity, lifestyle, sun exposure, and a host of other forces. A patient may come to Hamra looking for an eye lift or face lift, but like most plastic surgeons, he prefers to work an entire facial rejuvenation, combining several procedures to obtain the best, longest-lasting effects. He is disturbed by media promotion of quickie “lunch-hour” or “Wal-Mart” face lifts. Though less expensive, the shorter and more abbreviated the procedure, the less lasting the results. A lift, says Hamra, is like redecorating a room. Do it all at once so there is a flow, a synchrony to the finished look.

So can he help the aging starlet?

“She’ll be working again in a year,” he says.

“It’s Not a Magic Wand”

Sometimes plastic surgeons compare the face to a bedspread. A face lift pulls the bedspread up and smoothes it tight. But if you keep making that bed year after year, pretty soon the bedspread wears thin. You need to get a new bedspread.

Where does one find a new face? By resurfacing, removing the outer layers of skin. The newest tool is the CO2 laser, which literally burns off the top layer. It is faster than fast; because each pulse of energy is so powerful, the laser stays on the skin for a mere thousandth of a second. Carbon dioxide lasers send out infrared light invisible to the eye, peeling away the outer layer of skin. Water in the outermost cells absorbs the laser beam and vaporizes. As the laser dissolves the skin’s top layer, a gray residue resembling volcanic ash is left behind. The surgeon wipes it away and continues, re-vaporizing areas of deep lines. The skin’s raw dermis is exposed. The laser then heats the collagen in this vulnerable area to 60 degrees centigrade. (Over 65 degrees, there is permanent collagen damage.) This creates a slight shrinkage of the facial collagen-which you can see as the technique is being done. Like shrink-wrap, the skin pulls together, resulting in a mini-face lift.

“It’s not a magic wand,” says Dr. Jay Burns, a plastic surgeon who teaches laser skills to residents at Baylor and UT Southwestern. “You’re not going to look 19 again, and there’s no way you’ll be going back to work on Monday if you had the procedure on Friday.”

The laser is not a substitute for a face lift-in fact, muscular-driven wrinkles will return. It also will not improve a baggy neck. But it works wonders on fine and deep lines and wrinkles, dark and age spots, sun damage and discoloration. Once healed, the skin is smooth and uniform in color. Patients say their skin looks like it did when they were rosy-cheeked teens. They also say that laser resurfacing does not produce that pulled-too-tight, permanent-ponytail look some patients are left with after a face lift.

Patients of any age can undergo treatment, but only certain skin types can tolerate the laser. Burns says he turns down 30 to 40 percent of patients because laser resurfacing, like chemical peels, will discolor the darker skins of Mediterranean, Hispanic, and African-American people. Bums, who has done more than 600 laser resurfacing procedures, claims none of his patients has undergone scarring. But he has seen other surgeons’ mistakes and says he’s still learning.

“I was doing a woman one day and I realized that her skin was reacting differently to the laser,” says Burns. “It’s only because I have done so many that I knew something was wrong. We stopped and reduced the power. “

Recuperation time is at least 10 days or longer, while the skin generates a fresh new epidermis. Burns has his patients wear a mask for the first few days following surgery. He has found this decreases pain and swelling. Patients will not want to be out in public for the first week following the procedure; unless they know you’ve had plastic surgery, friends might be tempted to rush you to the burn unit at Parkland.

Suffering for Beauty

Jenny Saxon still cannot believe she went to the Medical City office of Dr. David Martin and agreed to a laser facial resurfacing within 30 minutes of walking in the door. Jenny, age 70, is an avid plastic surgery consumer. Mark Lemmon did her face lift 20 years ago; she’s also had liposuction and a tummy tuck. The week before, she’d seen a doctor on television actually lasering a patient right there in the studio. The laser, he reported, removes long vertical cheek lines and lip crevices-the very things that bothered Jenny about her own face. She asked her family doctor for a reference and got Martin’s name.

“I really wanted him to just sort of zap the lines, like they did on television, but Martin said he had to do the whole face for best results,” recalls Jenny. “I told him, OK, let’s do it!”

Three thousand dollars later, Jenny was totally unprepared for the pain she encountered after her laser resurfacing. Maybe, she says, it was her age; she is usually not a wimp when it comes to pain. But this procedure hurt.

“They told me it would feel like a real bad sunburn,” she says. “I thought I had had bad sunburns. But it was more like an acid burn…it hurt so much I almost couldn’t breathe.”

Jenny doesn’t blame her doctor, who made two house calls to check up on her. She does blame the media for making laser surgery sound easy, painless, almost fun. Just like it was done on television.

“The surgery took 45 minutes, maybe an hour,” says Jenny. “But that night at home, once the medication wore off, I was in agony. I’ve never been in that much pain before in my life. “

Jenny had the laser on a Friday; she didn’t sleep again until Monday, when her physician gave her a stronger pill for pain. She couldn’t read or watch television; relief came only from cold packs, resting with her head elevated, closing her eyes, and just waiting to heal.

parts of her face are scabbed over, particularly where the surgeon repeated the laser procedure to smooth away lines. Skin flecks fall from her face as she talks. Plastic surgery is not easy, she’s decided, and this will be her last transformation. As the French like to say, il faut souffrir pour être belle-you must suffer to be beautiful. Jenny has suffered enough.

Lords of the Thighs: The New Liposuction

Doctors have been pulling fat from patients for 13 years, ever since three European physicians figured chat what goes in through the mouth could come out through a thin vacuum tube called a cannula. Tumescent, the new buzzword in liposuction, allows surgeons to treat patients who have a larger volume of fat. In the “tumescent” proce-dure, large amounts of a solution-diluted anesthetic, saline, and epinephrine-are injected in the treatment area to mobilize the fat ap:d shrink blood vessels. Used along with the straw-sized cannulas (3 millimeters in diameter), tumescent liposuction can reduce bruising and post-operative pain. Incisions are so small they may not even require stitching. More fat can be removed-four to seven pounds, sometimes more. There is also less blood loss.

“Tumescent has improved recovery time as well,” says Dr. Natan Yaker, who practices in North Dallas and Piano. “How much fat you leave behind under the skin is what’s important in this procedure- you want the contour to look normal.”

Next? Ultrasonic-assisted suction lipectomy lurks around technology’s corner, awaiting FDA approval. Theoretically, ultrasound will literally melt the body fat and the cannula will pull it out, leaving blood vessels intact. Ultrasonic is still in the testing stage; surgeons think it will be useful for patients with massive fat deposits. Tumescent will still be used in conjunction with ultrasonic for refinement.

At a plastic surgery seminar last May, Dr. Robert Hamas heard about an interesting lipo experiment in Brazil. Surgeons took several patients, vacuumed one-half of their bodies with traditional lipo and one-half with ultrasonic. The result? No apparent difference.

“It’s becoming clear that ultrasonic will not replace traditional lipo,” says Hamas. “But we’ll have another option.”

Once removed, fat cells do not return to the area from whence they were yanked. However, a lipo patient who gains weight after surgery will increase the size of fat cells and simply gain weight in other body areas, Although they can now remove larger volumes of fat, plastic surgeons warn that liposuction is not a substitute for weight loss.



A Better Breast Goodbye, Hardwood Floors

THE BREAST AUGMENTATION BUSINESS IS PICKING UP AGAIN, DESPITE all the negative press and enough lawsuits to bankrupt the makers of silicone implants. Recent medical studies may have cleared the silicone gel implant of its nasty rap, but a patient desiring breast augmentation today can only have saline-filled implants. ( Note: implants from other materials, such as soybeans and polyethylene glycol [PEG], are pending approval.) Todays patient can choose from the regular round-shaped implants or an anatomical, “teardrop ” shape. She may have the implants inserted through endoscopic surgery in the armpit, through a nipple incision, or through an incision below the breast at the bra line. (Implants are pumped with the saline after insertion.) Most surgeons prefer to place breast implants below some of the pectoral muscle, but this varies with the patient and surgeon.

The number one complaint from breast implant patients used to be hard breasts due to “capsular contracture. ” That’s what happens when the body encapsulates a foreign object, be it a sliver, bullet, or breast implant prosthesis: scar tissue forms around the object. In some women it’s minimal, in others it s thick, hard, and requires popping. Surgeons have tried many ways to trick the body into not encapsulating breast implants. One method that seems to work: a textured surface implant. Simply put, nubbins on the implant s surface disorient collagen fibers so they cannot line up and form contracting scar tissue. Women with contracted capsular tissue from old implants can trade them in for textured implants. Thanks to textured implants, most surgeons no longer encourage implant patients to massage a lot after surgery to diminish capsular contracture. And patients are no longer told to lie on a hardwood floor for one hour every day to stretch and pop scar tissue.

Noses Better Than Nature’s

Turning the skin of the nose back for surgery is not exactly new, but a technique called open rhinoplasty is gaining popularity. Instead of working on the nose from inside the nostrils, surgeons make an incision at the base between the nostrils and peel the skin back up over the cartilage. Turning the nose inside-out yields a broader view; the surgeon can better deal with tip deformities, though a tiny scar will remain at the base of the nose. Old nose-jobs hid scars inside the nose. While that may have been a plus, they were also harder to do. In the old days, surgeons sometimes crushed and crunched cartilage. While the nose healed nicely and looked good for a year or two, scar tissue could form and contract over time, or the cartilage might become weaker after surgery. So the once-attractive nose could actually change shape.

“There are more than 200 variables to consider in a nose,” says Dr. John Tebbetts. “The open rhinoplasty yields 30 to 40 percent more options.”

Plastic surgeons consider rhinoplasty among the most challenging of plastic surgery procedures. As Dr. Jack Gunter points out, the doctor is working in millimeters in a very small space. The nasal anatomy must also be symmetrical; the surgeon who takes out the cartilage must put it back perfectly because there’s no hiding an uneven nose. Thus it takes a surgeon with not just skill but artistic ability to analyze a person’s face and God-given rhino, then figure out what to do. The patient’s body is the artist’s canvas.

“That’s what I’ve always loved about this work,” says Dr. Fritz Barton. “A canvas cannot show appreciation-but a person can.”

The Price of Beauty

HOW MUCH DOES IT COST TO BE BEAUTIFUL? THAT depends on how much beauty you want and where you go to get it: a doctor’s office or hospital. Most patients like the ambience of the office surgical suite-more personal, private, and pampering. And it’s almost always cheaper than a hospital. Tip: Even though the doctor’s office is sleek and elegantly decorated, make sure the office operating suite is accredited. There are two major accrediting agencies-the Accreditation Association for Ambulatory Health Care (847-676-9610) and the American Association for Accrediation of Ambulatory Surgery Facilities (847-949-6058).

Many doctors cut a deal if you have multiple procedures done at once, But beware of any slick doc who suggests repairs for body parts you think are quite fine, thank you.

The Wizards

You’ve probably seen their work for years. (Or maybe you are their work.)

dallas’ leading plastic surgeons are compulsive perfectionists. They are artistic and visually oriented, with a delight for aesthetic harmony. Beyond that, each has made a contribution to the field, teaching, doing research, fine-tuning a procedure, or even inventing a new way to sculpt the human anatomy.

Sam Hamra has lifted years off many a socialite’s and starlet’s visage during his 23 years in practice. With former partner Mark Lemmon, Hamra published his 6rst professional paper on face lifts back in the 1980s. About two years ago Hamra, one of the first to do the deeper face lift, started going against convention when doing lower eye work with his face lifts, leaving [he tatty tissue under the eyes in (most everyone else takes it out). He reasoned that men and women who have had face lifts still age, after all, and gravity would tug that lower eye skin like a water balloon, leaving the eye even more hollowed-looking without die fat pad. Hamra retains (or in some cases, adds), spreads, moves, and pats the natural fat down where it used to be. Published this year in a respected plastic surgery journal, Hamra s technique will likely be mimicked by more plastic surgeons across the nation.

Although Robert Hamas was one of the first plastic surgeons in Dallas to train in liposuction, his name is now internationally associated with the endoscopic forehead/brow lift-a way to smooth wrinkles from the brow and forehead. Two to tour tiny incisions, each about the size of a fingernail, are made in the scalp above the hairline. Through these the surgeon inserts the endoscope (acamcra/micro-scope attached to a tube-like instrument, permitting the physician to see inside). He works instruments down into the forehead region. Slack muscles are pulled up where they can be tightened. The eyebrows are raised, and patients get an eye lift as well, since pulling up the forehead imparts a youthful, wide-awake look to the eye area.

“It eliminates that heavy-lidded, tired-eyes look, and it’s done with minimal invasion.” says Hamas, who, when he was 5 years old, decided to become a plastic surgeon after having plastic surgery himself- an otoplasty to correct prominent ears.

Hamas also developed a way to smooth those vertical frown lines on the forehead between the eyebrows. Through hairline endoscopic surgery, Hamas snips the corrugator muscles. Once they’re cut, the patient can frown all he or she wants; no more wrinkles.

He’s been called the “Man of a Thousand Noses,” and Jack Gunter is considered a world authority on rhinoplasty. Besides plastic surgery, doing and re-doing noses from Dallas and everywhere, Gunter lectures, teaches his techniques, and writes countless papers and books on all aspects of plastic surgery. Gunter, who roomed with Sam Hamra in medical school at the University of Oklahoma, says he passed out in surgical trauma class the first time a plastic surgeon brought in slides of work in progress. Initially board-certified as an ENT (otolaryngologist), Gunter found he liked plastic surgery better. There were, he says, too many “gray” areas in ENT treatment. Plastics offered clear-cut answers and solutions. He closed his ENT practice and became a student all over again to obtain his plastics certification; surgeons say he was teaching the professors at Southwestern how to do a rhinoplasty while he was still a plastic surgery resident.

Gunter says the first time is usually the surgeon’s best chance to get a good result on a nose or any procedure.

” It’s always harder to go back and correct. That’s why people shouldn’t look for bargains in plastic surgery.”

It’s almost like recycling. Dr. H. Steve Byrd developed a way to bolster and support the nasal tip by grafting discarded septal cartilage into the nose and extending the septum to control the tip. In other words, if you’ve had an accident or a bad nose job and the tip of your nose is caving in like a roof after a twister, this man has the solution. Byrd also designed a measurement system using models to geometrically define the ideal nose; it’s proved helpful in teaching residents.

“Plastic surgery measures your surgical skills,” says Byrd. If you’re good, it shows. Byrd also developed the endos copie mid face lift. Going into the temples behind the hairline, he endoscopically changes the position of the cheek pad, resulting in a cheek lift. “It’s as if you pull up on the cheeks just above the cheekbone,” he explains. “Very popular with women in their mid-30s.”

He is a whiz with computers and can sculpt a decent nose. In fact, he is writing a book on rhinoplasty. But John B. Tebbetts’ worldwide reputation in plastic surgery is that of a breast man. After years of research and analysis, Tebbetts developed a tear-shaped (anatomical) saline implant manufactured by McGhan Medical Corporation. Fans of the anatomical implant believe it more closely resembles a natural contour, thus yielding a perkier breast; others call it a gimmick pointing out that once a regular implant is in the chest, gravity makes it naturally form the teardrop shape. Some say the teardrop implants are harder, since they are filled with more saline. They are also thicker-shelled and more expensive than conventional implants.

Originally channeled to be a heart and chest surgeon, Tebbetts says he loves the challenge of taking something and making it better.

“Much of aesthetic surgery is learning to see,” he says, “To recognize the great from the good.”

What a job. Jay Burns gets to play with all the new toys as a plastic surgery professor at UT Southwestern. In his case, the “toys” are lasers, which light up this doctor’s eyes. Burns has earned international fame as a laser expert. After doing more than 600 laser facial resurfac-ings over the last 18 months, this plastic surgeon teaches the laser resurfacing course at Southwestern and jets oil at least once a month to teach the method elsewhere in the world, He says there are about eight surgeons in the United States who really know how to handle and teach the use of that super-fast, super-hot wand-though Bums tries to be modest, he is one of them. He is hard at work on a teaching book about lasers, hoping to finish it before the technology changes.

FACE TO FACE: Picking the Right Doctor



HERE’S A CHILLING THOUGHT: ANYONE WHO HAS A LICENSE to practice medicine can call himself a plastic surgeon, How do you find the real McCoy? Ask a doctor you trust for referrals. Call the local medical society. If a friend raves about her doctor that’s a good sign. But wait a few months to see if she’s still happy with her results. Get a second opinion.

Ask many questions-about where the doctor trained, how long, and how many procedures he or she has done. Call the hospital the doctor is affiliated with and check his or her scope of privileges. Look for an artistic flair, a sense of style.

Above all, make sure the doctor is board-certified-and that’s where things can get fuzzy.

There are two types of plastic surgeons-diplomates of the American Board of Plastic Surgery and diplomates of the American Board of Facial Plastic and Reconstructive Surgery, Inc. Some plastic surgeons feel ABFPRS facial cosmetic surgeons are not as qualified to do procedures south of the neck, such as breasts and liposuction. Off the record, many ABPS plastic surgeons say the facial doctors took a shortcut to practice without a plastics residency. Cosmetic plastic surgeons counter that they do more aesthetic procedures, less trauma; they also say breast reconstruction and liposuction are cookbook pro-cedures-much easier to do than faces.

Bottom line: There are excellent surgeons in both groups, but your mission as a consumer is to find them.

“Facial cosmetic surgeons simply have a self-designated specialty,” says Dr. Fritz Barton, who is an examiner for the American Board of Plastic Surgery, “but that doesn’t mean they are not capable of doing good work. “

WHAT THE CREDENTIALS MEAN

American Board of Plastic Surgery: The ABPS (800-635-0635) was established in 1937 and has more than 4,000 diplomates in the United States. ABPS diplomates must have:

graduated from an accredited medical school in the United States or Cana

completed at least a three-year residency training program in general surgery or orthopedic surgery or been board-certified by the American Board of Otolaryngolo

completed at least two years of approved plastic surgery residency training in the United States or Cana

passed the written and oral board certification examination

At the University of Texas Southwestern Medical School, the plastic surgery residency is two years long. Surgeons do hundreds of cases (800 to 1,000) before they finish training.

American Board of Facial Plastic and Reconstructive Surgery: ABF- PRS (703-549-3223) has more than 300 members in the United States and Canada; one-fifth practice in California. Membership means the doctor:

completed a residency program in otolaryngology/head and neck surgery or plastic surgery approved by the Accreditation Counsel for Graduate Medical Education

has prior certification by either the American Board of Otolaryngology or the American Board of Plastic Surgery

has successfully completed a two-day examination

had two years of surgical cases (from clinical experience) scrutinized by a peer-review committee, including operative reports of at least 100 facial plastic surgeries

has proper licensing and subscribes to a code of ethics

Down the Tubes

Liposuction took a part of me-forever, I hope



GO TO SLEEP AND WAKE UP THINner-750 cc’s; a pound and a half; enough to fill three 8-ounce drinking glasses slimmer. After slowly losing 20 pounds and sweating it out at the Park Cities YMCA for IS months, I’d had it. I could hog those Cybex machines all day and start a riot in the exercise room, but some fat pockets would never go away. So I took the lipo plunge.

On Feb. 9,1 reported to Dr. Robert Hamas’ office wearing loose clothing and no make-up, bringing visions of a Christie Brinkley stomach, 1 had run two miles the night before knowing I’d be sedentary for two weeks. I took the tranquilizer he prescribed to calm nerves, but didn’t really need it, having been down this road before. (Dr Jack Gunter did my nose in 1983.) Then came the general anesthesia (tumescent liposuction can be done under local anesthesia, but it takes up to four hours), and I was gone, drifting off with visions of beaches, bikinis, and hunky looking men.

While I slept, Hamas made two tiny (quarter-inch) incisions below the “bikini line” (what bikini?). From these he literally vacuumed my abdomen all die way up to and above the navel. The cannula tube is smaller than a McDonald’s straw, but Hamas found die fat. Lots of fat.

“I was pretty aggressive,” he told me later, meaning he skimmed off as much fat as he could.

Removing fat means some blood loss, since our bodies form blood vessels in fat deposits. Human fat is not like the white stuff you trim off a steak; when vacuuming fat you are also pulling and breaking many tiny blood vessels, though the tumescent procedure shrinks them. It is normal to remove a small amount of blood as well, which lends a peachy tinge to the human fat.

And there it sat after the surgery, all 750 cc’s in a beaker. I was concerned with sagging. What would happen to the vacated space once the fat was evicted? Bellies are not commercial office space, but when occupancy rates are low, empty offices don’t exactly shrink.

That’s why God created girdles. They had pulled one on me before I woke up (a feat that no doubt gives plastic surgeons terrific biceps). I would wear that girdle for four weeks, for the first two weeks day and night. For this reason I do not recommend liposuction during August in Texas.

I expected instant results. I also expected pain. When I awoke, there was a strange burning sensation across my abdomen. By the time I was wheeled into the recovery area, it had ceased.

“OK,” I said, glancing at the TV. Being a somewhat neurotic doctor’s wife-I even nix X-rays at the dentist’s office-I like to know what they’re putting in me. “So what have you just given me for pain?”

Nada. The burning I felt was the local anesthetic swimming across my tissues. It stings initially, then subsides. In fact I didn’t take any pain médication at all the entire first day. I was home by 3:30 p.m.; read the mail, talked on the phone, and went to bed. But not before I got on the scale. And almost fainted. I had gained 5 pounds when in fact I had not eaten in 36 hours and my plastic surgeon had just pulled out 750 cc’s of fat out, “Fluid,” he explained, “It will be gone in a few days. Trust me.”

So I had my answer. You are not immediately slimmer after liposuction. You are full of anesthetic solution and your body reacts to the surgical trauma by sending body fluids via FedEx to the suctioned areas. So you swell up across the lower abdomen. Men, my surgeon says, find this swelling does surprising things to their lower extremities.

As for pain, surgeons say you’ll feel like you’ve had a strenuous workout, overworked your muscles. I felt more like I’d fallen off a horse (onto my stomach) but it was never an unbearable pain. (Childbirth, by comparison, was more like falling off the horse and being dragged around for several hours.)

We watched videos on the night of my surgery, and it was nice being waited on hand and foot by the family. My husband did his part, even picking up the newspaper from the bathroom floor. Liposuction has many rewards.

The night following surgery my husband and I helped chaperon our daughter’s eighth grade Valentine’s Day dance. He did the walking; I sat, feet elevated, eyes alert for any taboo behavior. That night I paid the price for disobedience-increased swelling. (OK, I confess, we danced one dance.) I finally took a pain pill. Rested again on Sunday and the swelling went down. By Tuesday I was feeling almost normal. I couldn’t bend over comfortably until the end of the first week. I was a bit black V blue. But what a small price to pay for a Cosmo-girl tummy.

Bruising vanished in two weeks. Let’s say I’m not ready for bare-midriff clothes or up to posing for Playboy. My navel is a bit wrinkly, but the abdomen definitely looks better, flatter. Clothes fit much better just in time for bathing-suit season.

I know this must be psychological, but tor two weeks after the surgery all I wanted to eat was healthy veggies and fruits. I turned down Celebrity cinnamon rolls, La Madeleine croissants, and Chicago-style pizza. Understand, this never happened before. Was it motivation?

Or was it the photo of 750 cc’s of peachy-gold liquid fat taped to my refrigerator? -M.C.E.