More and more women (men too) are choosing to have various features
refashioned or readjusted – but cosmetic surgery, like any operation,
is serious business. To bring you up-to-date on what can be done,
what risks you run, and what’s new in the field, here’s a timely
summary of techniques that have the potential to change your looks
TAKING YEARS OFF YOUR FACE
Surgeons used to erase signs of aging by pulling and tightening
the skin – leading to jokes about Hollywood beauties who underwent
so many face lifts that they had to sleep with their eyes open.
Now many doctors operate on underlying muscle and tissue to reduce
sagging and smooth creases from the inside out. They say this technique,
called the SMAS-platysma face lift (it’s named for the muscles involved),
lasts several years longer than skin-only procedures:
In the traditional operation, the surgeon makes incisions all
around the hairline, separates the skin from underlying fat and
facial muscle, pulls it up and back, trims the excess, and sutures
the skin in place. In the SMAS-platysma face lift, surgeons go two
layers deep instead of just operating on the top layer. They tighten
muscles and fibrous tissue beneath the skin of the face, chin, and
neck. It’s somewhat like the difference between making a bed by
neatening the spread, and pulling up the sheets and blankets as
In recent years, some women have begun getting face lifts in their
late thirties and early forties instead of waiting until after fifty,
when more work is needed and skin is less resilient. “It’s a lot
easier to take a bit of skin from under someone’s chin at thirty-nine
than to take out the turkey wattles at fifty-nine,” says John M.
Goin, M.D., a Los Angeles plastic surgeon.
A new wrinkle in face lifts is the use of suction-assisted lipectomy
(liposuction) on the neck and jowls. “With this technique,” says
a New York City plastic surgeon, “we can obtain a cleaner contour
of the neck and cheek lines.”
Blepharoplasty, the operation to remove the fat and excess skin
that cause droopy folds above the eye and bags below, is often done
at the same time as a face lift. Incisions follow the natural crease
lines of the lid, so they are difficult to spot.
Sunglasses must be worn for about two to three weeks after surgery
because eyes are swollen, bruised, sensitive to bright light, and
prone to tearing.
Another procedure, used when eyebrows have descended or there
are deep wrinkles in the forehead, is to make an incision in the
scalp, two or three inches above the hairline, and pull the forehead
up. This restores the level of the eyebrows and smooths the wrinkles.
It’s a simple operation that can be done on an outpatient basis.
Anyone who already has a high forehead, however, might be cautious
about opting for this procedure, since it will pull the hairline
back even farther.
Though a face lift leaves temporary swelling and bruises it’s
possible for a vigorous patient to be up and about fairly soon.
One San Francisco businesswoman met a new man for drinks in a cocktail
lounge a week after an operation to have the lower part of her face
and neck lifted. “I had little sutures all over, but I wore my hair
so it covered them and just prayed that the wind wouldn’t be blowing
when we left!”.
“I hate a nose that looks like a nose job,” says Peter McKinney,
professor of clinical surgery at Northwestern University Medical
School. He believes it’s far better to remove small amounts of bone
and cartilage than to do too much and have regrets. “It’s very difficult
to build a nose back up-much easier to take a little more off later,”
The goal, according to John E. Sherman, assistant clinical
professor of plastic surgery at New York’s Mount Sinai School of
Medicine and attending surgeon at Beth Israel Medical Center, is
to end up with “a straight nose that is in balance with the rest
of the face, as opposed to the old ‘manufactured’ nose that was
overly reduced, with a pinched tip.”
During this procedure, called rhinoplasty, the surgeon works through
an incision inside the nose to sculpt, removing bone and cartilage.
After surgery, the nose is covered with a protective splint for
a week to ten days. Postoperative bruises around the eyes fade gradually
over two to three weeks, swelling of the nose subsides in about
three months but may take up to a year to disappear completely.
A Miami-based writer who had her nose shortened and narrowed says
it was worth it to look, briefly, like a panda. “I wanted it done
because I was generally gawky, and my nose was one of the gawkiest
aspects of my life!”.
CHOOSING A SURGEON
The first step: Get names from doctors you trust. “Ask your gynecologist
who he or she would recommend,” suggests Gustavo A. Colon, associate
professor of plastic surgery at Tulane University. Then check their
credentials and those of the clinics or hospitals where they operate.
Doctors certified by the American Board of Plastic Surgery have
completed a three-year surgical residency plus an additional two-year
specialty residency in plastic surgery. Medical experts say certification
by a specialty board is your best assurance that surgeons know what
they are doing.
Be aware that no law requires a doctor to have formal training
in plastic surgery to do a face lift. All he needs is a medical
license – and lots of nerve. “That’s why it is so important to ask
if he’s board certified,” urges Dr. Colon. “And does he do a lot
of operations?” Dr. Peter McKinney agrees that you should be wary.
“You are not buying a toaster. Surgery shouldn’t be taken lightly.”
Both doctors recommend that you not rely totally on before-and-after
pictures, because certain patients have such good bones and skin
that a surgeon cannot help but make them look terrific. In addition,
ask for names of patients to interview; they will probably tell
you frankly what they like and dislike about their doctor.
What about doctors and clinics that advertise on TV and in other
media? According to proponents, advertising makes information about
plastic surgery available to people who might not get any from other
The American Society of Plastic and Reconstructive Surgeons, concerned
that advertising not seduce or cajole, recommends that ads be limited
to basic information about office hours and locations. Dr. John
Goin, a former president of the group, dislikes ads showing elegant
women in romantic or professional situations that imply that cosmetic
surgery can change your life. Dr. Colon agrees: “Ads that imply
‘Come to us and get beautified and find the job you’ve been looking
for’ may suck someone in to have surgery who hasn’t thought about
it carefully. They treat cosmetic surgery as a commodity, like cornflakes,
as if it were always safe and innocuous, with no problems.”
RESHAPING YOUR BODY
Suction-assisted lipectomy is a relatively new and increasingly
popular way to flatten fatty bulges that nature giveth and that
no amount of dieting can taketh away. The procedure is not an alternative
to dieting; it can help women who are trim on top but have bulging
hips, thighs, buttocks, and bellies. Someone cursed with saddlebags
but blessed with youthful, elastic skin that will quickly hug her
post-lipectomy shape is the ideal patient. “The better the skin,
the better the result,” says Gilbert Gradinger, a San Francisco
area plastic surgeon and clinical professor of plastic and reconstructive
surgery at Stanford University Medical Center.
The surgeon makes a half-inch incision, then inserts a hollow
tube attached to a suction machine. The tube is maneuvered back
and forth to loosen the fat, which is suctioned off with high vacuum
pressure. Afterward, the area is tightly bandaged for several days.
Some patients may need to wear long-legged girdles for a few months
to help the skin shrink to size. But be forewarned: Lipectomy is
not designed to eliminate cellulite dimples.
These days, such surgical procedures as tummy tucks and seat lifts
are usually done in conjunction with suction lipectomy, allowing
surgeons to make smaller incisions and do finer sculpting than they
could with surgery alone.
Abdominoplasty is often performed after childbirth or a large
weight loss to reduce excess abdominal skin and tighten the underlying
muscles. The surgeon makes a curved incision that swings from one
hipbone down to the pubic bone and back up to the other hipbone.
Another incision is made around the belly button. The skin is loosened
from pubic bone to breast bone. Then the surgeon takes tiny stitches
in the abdominal muscles, pulls the skin down, cuts away the excess,
makes a new navel opening, and stitches the incisions.
“Think of pulling down a window shade. We pull down a layer of
tissue to tighten the tummy,” says Fredrick Grazer, associate professor
of plastic surgery at the University of California at Irvine. Before
lipectomy, he says, abdominoplasties produced bellies that were
too flat-looking. Today, sur