Thinking Plastic

By staff November 1, 2001

New York plastic surgeon Dr. Darrick Antell asks every new patient to stand in front of a mirror and point out what bothers them most about their appearance. One day, after pointing to numerous areas, an exasperated woman cried out, "I haven't got enough hands!"

"This was actually a very level-headed, intelligent woman," he says, but her outburst shows how easy it is to become discouraged in a society where people want to keep looking young as they age.

Cheri Crum, office manager (and patient) of Sarasota plastic surgeon James Marsh, says, "What I hear from most patients, including myself, is the sadness they feel when looking in the mirror. They look tired and worn on the outside, but feel very young and vibrant inside."

For these people, a variety of procedures from facelifts and eyelifts to breast augmentation, tummy tucks and liposuction are making it possible to attain a fresher face, body and outlook on life.

According to the American Society of Plastic Surgeons (ASPS), more than 1.3 million people had cosmetic surgery last year. That's an increase of 198 percent over the past decade.

"Baby boomers have grown up with plastic surgery," says Marsh. "Now it's almost a status symbol."

When patients express concerns about their vanity, he tells them, "It's the way you present yourself to the world. Some people want to spend their money on expensive cars and homes. Some people want to spend their money to preserve their appearance."

In addition, says Marsh, many patients are now choosing to have several procedures done at the same time. He estimates that 90 percent of the surgeries he performs involve multiple procedures, usually a combination of a facelift, eyelift and reshaping the tip of the nose. (The ASPS says that nationwide, nearly a third of all cosmetic surgery patients had multiple procedures at the same time.)

One of the most often-cited reasons for combining surgeries is that you're often combining recovery times, too. "It's the same recovery time whether you have three procedures as if you had just one," points out Marsh.

Another reason people opt for more than one procedure at a time is convenience. According to Marsh, after the age of 50, people take longer to recover from any surgery. And few people seem to have time to spend on extended recoveries. Even his retired patients frequently tell him, "I'm busy! I don't have time to waste on this!"

For other people, though, it's a matter a money. Patients frequently try to hold down operating room costs by asking for as many procedures as they can get at one time.

One thing Antell discourages-strongly-is multiple surgeries involving more than one geographical area of the body. "And I have people coming in all the time asking for them," he says. "It's very common to do the face and eyes, but I get concerned when someone wants a tummy tuck or a breast lift at the same time."

Each procedure incurs its own risk, he says, and when a person is under anesthesia too long, complication rates go up. Citing increased risks for pulmonary embolisms and even pressure sores, he prefers to limit surgeries to three-and-a-half hours.

"Finances should never be the motivating factor" in planning cosmetic surgery, he says firmly. To encourage patients to split up complicated procedures, Antell often offers to waive operating room fees for up to six months. "I'd rather do two shorter procedures than one long one" that could endanger a patient's life, he stresses.

Whatever your reasons for choosing cosmetic surgery, you should weigh all your options-and risks-carefully before proceeding. "Some people come to a plastic surgeon thinking it's like getting a manicure or their hair done," says Antell. "It's not."

Cosmetic surgery can do a lot toward reversing the laws of gravity and erasing youthful frivolities, but people should be aware of its limitations. (Marsh insists upon several pre-operative visits to determine if a patient's expectations are unrealistic.)

"My family loves me the way I am," says office manager Crum. "They don't always understand why I would feel I need the surgeries.this is where I stress to do the surgery for yourself and not to please anyone else."

She advises potential patients to look for a conservative doctor who can "leave you with a nice, natural look. He can't make you look 18 again, but he should be able to make you look the best for your age."

Besides, she adds, "Who of us really wants to be 18 again?"

How to choose a good plastic surgeon

The American Society of Plastic Surgeons offers the following suggestions for choosing the cosmetic surgeon that's right for you.

1) Ask for recommendations from friends who have had the procedure you're considering. If you're lucky enough to know operating nurses, they can give you an informed opinion of plastic surgeons that they have worked with. Your family doctor may also have recommendations. Or contact the American Society of Plastic Surgeons at (888) 475-2784 or at their Web site:

2) Once you have a doctor in mind, check for certification. Doctors who are certified by the American Board of Plastic Surgery must complete at least five years of residency in addition to their medical training, and pass comprehensive exams.

3) Make sure the surgeon has hospital privileges. Even if your surgery is to be performed at his or her office, hospital privileges subject the surgeon to peer review and approval.

4) Ask questions. Make sure your surgeon addresses all your concerns and discusses your motivations-and expectations-fully. Make sure you understand the risks involved, and don't be pressured into anything you're not comfortable with.

Recommended reading:

"The Smart Woman's Guide to Plastic Surgery: Essential Information from a Female Plastic Surgeon," by Jean M. Loftus, M.D.

"Lift: Wanting, Fearing, and Having a Face-lift," by Joan Kron.

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