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
forever.
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
well.
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!”.
NICER NOSE
“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,”
he says.
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
sources.
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, surgeons use lipectomy to give a more natural
look by recreating the slight vertical depression that runs down
the center and around the belly button.
A twenty-nine-year-old aerobics instructor from Newport Beach,
California, had abdominoplasty to restore her abdominal muscles
after the birth of her second child. “I’m five feet tall and weigh
ninety pounds. He weighed nine pounds,” she explains. Three months
after the surgery, the incisions were barely visible. “I really
did it for medical reasons, not merely for cosmetic ones,” she
says. “But I do have a really nice, flat stomach now.”
Buttock lifts are seldom done because the scars show in a bathing
suit and can stretch uncomfortably when you sit down. Surgeons can
make incisions higher so they are less obvious, but the result is
a flatter rear end, which may not be pleasing either. “Surgery sometimes
requires a trade-off of one defect for another,” says Dr. Grazer.
Flabby, baggy upper arms can also be reduced by a combi-nation
of suction lipectomy and plastic surgery. The drawback? A long vertical
scar from armpit to elbow.
MORE BEAUTIFUL BREASTS.
The most common cosmetic surgical procedure is not a nose job
or a face lift but breast enlargement. The woman in her twenties
or thirties who has waited long enough to know that nature will
never give her big breasts is the most typical breast-augmentation
patient. According to Gary Brody, clinical professor of plastic
surgery at the University of Southern California, who has been performing
breast implants for twenty-two years, surgeons now know that breasts
will tolerate larger implants than was once thought possible. As
a result, women are having their breasts made larger than ever.
(New York City plastic surgeon Lawrence Reed points out that larger
implants are used more in California than on the East Coast… but,
even so, he says, “no one has ever come back to be made smaller!”
About four or five patients a year ask Dr. Reed to exchange an existing
implant for a larger size – a fairly simple procedure.)
During the operation, one incision is made just above the lower
curve of the breast and another along the lower border of the areola,
the dark skin surrounding the nipple. The surgeon lifts the breast
away from the chest wall to create a pocket for an implant – a flexible
plastic pouch containing silicone gel or saline solution. The operation
leaves only small scars that even the skimpiest bikini covers.
When breasts sag, they can be lifted with an operation called
a mastopexy. The surgeon removes a crescent-shaped section of excess
skin from the lower part of the breast, then raises the underlying
breast tissue and moves the nipple to a higher position. This operation
leaves a curved scar at the base of the breast, another scar from
the base to the nipple, and a third surrounding the areola.
Unlike augmentation and mastopexy, breast reduction isn’t considered
purely cosmetic, because enormous breasts can cause stooped shoulders,
backaches, and chest pains. Therefore, medical insurance sometimes
covers the cost. The most common operation is called brassiere-pattern
skin reduction. Working through horizontal incisions about two-thirds
of the way down the breast, the surgeon removes tissue, skin, and
fat from the sides and bottom of the breast. The nipple, part of
the areola, and the underlying tissue are moved upward. After this,
skin on both sides of the breast is brought to the center to enclose
and contour the smaller breast.
Reduction mammoplasty leaves extensive, permanent scars, but since
they are in the folds of the breast and around the areola, they
are easily concealed by clothes and bathing suits. Breast reduction
may also interfere with the ability to breast-feed.
The major advance in breast surgery, according to Dr. John
Sherman, is use of the body’s own tissue to help in reconstruction
after a mastectomy. “By incorporating an abdominal lipectomy,” he
explains, “excess skin and muscles can be elevated in one operation
to reconstruct the missing breast. The occasional complications
caused by use of a silicone or saline prosthesis are eliminated,
and the breast looks and feels more natural.”.
OUTPATIENT SURGERY
Because most plastic surgery patients are basically healthy people,
it is often possible to have an operation performed outside of a
hospital and go right home to recuperate. Dr. Colon estimates that
having outpatient surgery and spending the recovery period at home
can cost 50 to 70 percent less than checking into a hospital for
a few days to undergo the same operation.
A clinic should be fully equipped, not only to handle medical
emergencies but also to provide follow-up care after the surgery.
Someone on the clinic staff should call patients the evening after
surgery and the next day to check on their progress. Patients should
have a clear list of post-surgery dos and don’ts and easy access
to a person who can answer questions by phone.
Even surgery performed under general anesthesia can now be done
on an outpatient basis because of changes in hospital regulations
and the availability of anesthesia in private offices according
to Dr. Sherman. “These procedures include suction lipectomy,
eyelid lifts, and mastopexy,” he says. “Among other operations,
face lifts, rhinoplasty, brow lifts, and breast augmentation can
be performed under local anesthesia and without a lengthy and expensive
hospital stay.”.
WHAT CAN GO WRONG?
Although any surgery involves a certain amount of risk, plastic
surgery is less risky than most operating-room procedures because
patients start out healthy. Also, most of the work is done on the
face and upper part of the body-areas that have a larger and richer
blood supply and therefore tend to heal quickly.
When surgery is done in an office or private clinic (away from
the germ-laden hospital environment) and under local anesthesia,
the chances of infection and other complications are notably lessened.
Nevertheless, risks do exist, and the more extensive the surgery,
the more opportunities there are for something to go wrong. Nerve
damage is possible, and any patient can have poor scar formation.
In some cases, scars must undergo additional surgery in order to
be excised.
After breast augmentation, there is a chance that internal scars
may form around the implant, compressing it until it becomes too
firm. When this happens, a second operation may be necessary.
The complication most closely associated with cosmetic surgery
is excessive bleeding. It can cause a hematoma – an accumulation
of blood – which may have to be surgically removed. To minimize
the risk of excessive bleeding, most doctors advise that you refrain
from taking aspirin or any aspirin-containing products for three
weeks prior to surgery. There is also an increased risk of bleeding
among patients on the Pill, so you should consult your doctor about
the advisability of switching to another birth-control method.
Depending on the type of surgery, activities such as jogging and
swimming may be taboo for some time afterward. Carefully following
the convalescence regimen outlined by your surgeon will minimize
postoperative complications.