Plastic Surgery Guide

This is the most popular cosmetic procedure among both men and women. It is also the procedure that will produce the most dramatic change in a patient's appearance. Rhinoplasty is performed to reduce the size of the nose, reshape the nose or tip or remove bumps or other imperfections. The incision is usually made inside the nostril. This provides access to the nasal bone and cartilage while preventing the scar from being visible. Postoperative pain is rare, but swelling inside the nose may make it feel stuffy. Swelling and bruising will diminish after a few days. Most people can resume normal activity - with the exception of strenuous exercise - within a week.

Blepharoplasty (Eyelid Surgery):

The eyes are a popular site for cosmetic surgery because that's where the first signs of aging appear. People may also inherit a tendency toward "bags" - or accumulations of fat - around the eye-lid. These bags may occur early on, before other signs of aging appear. The procedure can remove the excess skin and fat to create a more youthful experience, but it won't eliminate the fine wrinkles and crow's feet around the eyes. Incisions are made in the fold of the upper lid and in the crease directly below the eyelashes in the lower lid. Scarring from these incisions is virtually unnoticeable. Post-operative swelling and bruising are usually mild. No dressings are placed over the eyes, so vision is not impaired. Most patients can return to work within a week.

This is the second most popular cosmetic procedure after rhinoplasty. As the population ages, it is gaining in popularity, especially among men. A facelift tightens loose and sagging skin in the face and neck. Incisions are made behind the hairline in back of the cars. Any scarring that remains visible after healing can usually he hidden by hair. Excess skin and fat are removed. Underlying muscle and connective tissue are tightened. Postoperative swelling and bruising usually last longer than in other procedures, about 1-2 weeks. Because of this, the full effect of a facelift is usually not apparent for 3-4 weeks. Some patients report a tightness or numbness in the face and neck following the procedure. How long these sensations last depends on the individual patient.

Forehead Lilt:

1 his procedure is often performed in combination with a facelift or blepharoplasty. It elevates drooping eyebrows and eliminates forehead wrinkles. An incision is made behind the hairline, hiding any resultant scarring. Underlying muscle and skin are tightened and excesses are removed.

There is usually some post-operative pain. 'fire swelling and bruising will disappear in about 10-14 days. There is a loss of sensation between the area of incision and the center of the head because nerves are severed in the process.

Mentoplasty (Chin Implants):

This procedure is often performed in conjunction with rhinoplasty to create a more balanced profile. According to Glasgold, a receding chin may exaggerate the size of the nose and its correction is as important to the overall result as is the nasal procedure. The incision is usually made inside the mouth, or sometimes under the chin, and the implant is fixed in position against the jaw bone. Over time, it blends in with the natural contour of the jaw and feels like a part of the hone. The implants are made of solid silicone and, Glasgold says, "patients should be aware that in more than 25 years of using these implants, there is no evidence of adverse effects on the body." Since the implants are solid, there is no danger of rupture and leakage, as there is with breast implants. Similar implants are also used in the middle of the face to make cheekbones more prominent in an otherwise flattened facial contour.

Liposuction:

This procedure removes pockets of excess fat to reduce an area that is out of proportion to the rest of the body. It is not a substitute for diet and exercise for overall weight reduction. Rather, it is most effective in patients with a normal body build who have one or two areas that seem to be diet- and exercise-resistant. Tiny incisions are made in the tar-get area and a tubular suction instrument is inserted. The fat to be removed is separated, then suctioned out. A snug elastic dressing is worn after the procedure to promote skin shrinkage. Depending on the elasticity of the skin and the amount of fat removed, a surgical procedure may he necessary to remove the excess skin from the area. Liposuction can be done on almost any part of the body: abdomen, thighs, arms, hips, even the face and neck. Postoperative swelling and bruising subsides gradually, and may not completely disappear for 6-8 weeks. Skin imperfections that were present before the procedure, such as cellulite dimpling, will remain.

There are also a number of noninvasive, and even non-surgical, cosmetic procedures to help improve the appearance and texture of skin.

Laser resurfacing is growing more popular as the technology is becoming more precise and the cost of the equipment becomes less prohibitive. Lasers work by burning through tissue. Because they burn, rather than cut, they cauterize blood vessels and result in much less blood loss.

Laser resurfacing can be used to remove tattoos, age spots and areas of sun damage. In fact, lasers are virtually the only effective method for removing tattoos and port-wine-stain birthmarks.

They are also used to burn off the outer layers of skin to reduce wrinkles and blemishes. Because of their precision, lasers are especially effective at removing wrinkles in delicate facial areas, such as those around the eyes and mouth.

Laser treatment can be faster than other surgical procedures, with a session lasting from 30 to 90 minutes. More extensive results are usually achieved with multiple sessions.

Although lasers are less invasive than other surgical techniques, they are not completely painless. Some sedation and local anesthesia are usually required. Following the procedure, the treated area may crust over, accompanied by bruising and swelling. These reactions usually sub-side within a week or two. The affected area will also appear sunburned. The redness will subside over the first month, but may last as long as six months. The surgeon may prescribe medicine that can lessen the effect, and make-up can be used to camouflage the redness after about two weeks. The treated area should also be well protected from sun exposure during the healing process.

In rare instances, laser resurfacing can result in permanent darkening of the skin. For that reason, patients with olive or darker-toned skin are not good candidates for the procedure. For such a patient, it is recommended that the surgeon first do a patch test in a hidden area (such as behind the ear) to gauge the results.

Patients with active acne, herpes, or a skin infection such as impetigo, as well as those who have used the acne drug Accutane within the previous 12 months, are also not candidates for a laser procedure. These conditions increase the risk of keloids, which are hard, irregularly shaped, raised scars.

Dermabrasion can also smooth out small wrinkles, as well as reduce rough scars and other skin irregularities. Scars, wrinkles and marks left by acne or chick-en pox are "sanded" to make them smoother and less noticeable.

Following the procedure, the treated area seems raw. It crusts over and heals within eight to 10 days. The crusting falls away to reveal smoother skin that is somewhat reddened. The redness will subside over a few months, but can be covered by make-up after two weeks. Dermabrasion is often performed in con-junction with a facelift.

Chemical peels are a completely non-surgical way to reduce wrinkles and blemishes and improve the texture of the skin. Peels come in different strengths, but all involve the application of a chemical solution to the face.

Like laser resurfacing, chemical peels remove the outer layer - or layers, depending on the strength - of skin so that softer, smoother skin can grow to replace it. Often they are performed in a series and combined with a prescribed skin care regimen. Peels can also be used to enhance the results of a surgical procedure.

Many cosmetic surgeons are offering these procedures as part of their practice. Make sure to schedule a consultation with the person who will be performing the procedure (not necessarily a surgeon) to be sure the procedure and the person are right for you.

Checklist

1. Check with the New Jersey State Board of Medical Examiners to make sure that any surgeons you are considering are licensed in the state. You may also be able to find out about any complaints or lawsuits filed against these practitioners (information follows).
2. Check with the American Board of Plastic Surgery or the American Academy of Cosmetic Surgery to determine if your chosen surgeon is hoard-certified (infor­mation follows).
3. Check the surgeon's experience and familiarity with the particular procedures you are considering. Find out how often he or she performs those specific proce­dures.
4. Ask to see before and after photos of patients who have undergone the pro­cedures you are interested in.
5. Ask for a realistic idea of what kind of results to expect. Most surgeons will be able to give you an idea of what to expect using sketches or computer imag­ing.
6. Consult with more than one surgeon. Choose one whom you trust and with whom you feel comfortable. Keep looking until you find the one that feels "right."
7. Inquire about the staff/patient ratio, especially if you are going to be anes­thetized.
8. Ask about the risks, benefits and possible complications of the procedure. Ask how long the results will last.

Places to Call: New Jersey State Board of Medical Examiners (609) 292-4843; American Academy of Cosmetic Surgery (800) 221-9808; American Board of Plastic Surgery (215) 587-9322; American Society of Plastic and Reconstructive Surgeons, Inc. (800) 635-0635. Certification Requirements

To be certified by the ABFPRS, a physician must complete a three- or four-year general surgical residency followed by a two-year residency in plastic surgery. To be board-certified as a facial plastic surgeon, a prospective member must complete a one-year general surgical residency; a four- to five-year residency in otolaryngology and head and neck surgery, including facial plastics; and a one-year fellowship in facial plastic surgery.

To be certified by the ABCS, a surgeon must first be hoard-certified in an original specialty recognized by the American Board of Medical Specialties and the American Medical Association (including plastic and reconstructive surgery). The surgeon must also have been in a practice dealing primarily with cosmetic surgery for the previous five years and have per-formed at least 1,000 cosmetic operations.

Applicants for certification by either board must pass written and oral exams and he reviewed by certification committees.

You may need to ask the surgeon what should he done. "Sometimes patients are unhappy with their appearance but they're not sure why. They're uncertain about what needs to change," Glasgold says. "A well-trained cosmetic surgeon will be able to recommend changes that will give you the result you want.

"Many cosmetic surgeons also have computer imaging facilities. If your surgeon offers this, take advantage of it. The computer image can give you a pretty accurate idea of how you'll look after a particular procedure."

"Having a procedure done won't magically improve your life," Glasgold said. "But if it makes you feel better about yourself, then it's a worthwhile investment."

It's also a good idea, according to Glasgold, to find out what to expect after the surgery. Ask about the kinds of complications that can arise and how to deal with them.

Some cosmetic procedures may not be major surgery, but they're still surgical procedures and carry risks inherent to any surgery: reactions to anesthesia; infections; and blood loss. Cosmetic procedures carry the risk of other complications following surgery as well. In the case of a nose job (rhinoplasty), you may experience breathing difficulties. Blurred vision may follow eyelid surgery (blepharoplasty). "These complications often reverse themselves over time, but in some cases, a second procedure is necessary to correct them," warns Glasgold.

Ask if you'll need help at home or if you can he left by yourself. If you must change dressings or care for the wound, inquire if someone in the office will show you how to do it.

Your surgeon should tell you about the average recovery time for your procedure and how long it will he before you can resume your normal activities. The surgeon should also tell you how much pain to expect and how to alleviate it.

Unfortunately, most cosmetic procedures don't stop the hands of time. Often they must be repeated every five to 10 years to maintain an improved appearance. So check with your surgeon about how long the benefits of a procedure will last.

Now that you've decided on a surgeon and a procedure (or two), what can you look forward to? Pain? Swelling? Bruising? The answer, according to Glasgold, is none, some or all of the above.

"How a person reacts to and recovers from a procedure depends on the procedure itself and the individual patient," Glasgold says. "What causes swelling and discoloration in one patient may have little effect on another. And the same patient may have differing reactions to separate procedures."

Glasgold cautions that the reaction to the results of cosmetic surgery depends on the patient (and his or her expectations) and the procedure. The beneficial results of rhinoplasty are usually apparent immediately following surgery. In contrast, because of bruising and swelling, it can take several days for the results of eyelid surgery to become apparent, and several weeks to see the effects of a facelift. "So a patient shouldn't be surprised or disappointed if the change isn't immediately apparent," Glasgold adds.

Most procedures these days are done through small incisions; consequently, patients suffer minor, if ally, pain. Because incisions are small, scarring is less noticeable and, where possible, incisions are made where they can be concealed. For example, they are made behind the hairline in a facelift or a forehead lift and inside the mouth for facial implants.

According to Glasgold, the majority of cosmetic surgery patients are women, but an increasing number of men are undergoing these procedures "for professional reasons," he says. Glasgold notes that an increasing number of young people are seeking cosmetic surgery and as long as the patient has reached full physical maturity, performing the procedure is not a problem. In fact, depending on the circumstances, cosmetic surgery can do a lot to improve a teenager's self-confidence.

None of this revising, reshaping or rejuvenating comes cheap. In New Jersey, the rates vary from county to county. A survey conducted by New Jersey Savvy living shows that surgeons located closer to New York, such as those in Bergen and Essex counties, charge more than do those in southern New Jersey. But in general, you can expect to pay about $2,000 for eyelid surgery and $5,000 for a facelift. Add another $1,000-$2,000 for the facility's fee and about S 1,000 for anesthesia and the bill could easily approach $10,000 for a single procedure. And, since cosmetic surgery is elective, it is not covered by medical insurance. In some cases, when the surgery corrects a structural problem resulting from trauma or a congenital abnormality, medical insurance may cover a portion of the cost.

In spite of the cost, more than one million people nationwide undergo cosmetic procedures each year. "Having a procedure done won't magically improve your life," Glasgold said. "It won't make you rich or get you a better job. But if it makes you feel better about yourself or perceive yourself in a better light, then it's a worthwhile investment."

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