Cosmetic Surgery: Facts, Mistakes & Complications
Cosmetic Surgery Facts
Surgeons
Cosmetic Surgery involves a broad range of surgical procedures to improve personal appearance involving complicated as well as simple surgeries; hence it is legal in the United States for any qualified physician to perform cosmetic surgery. However, a doctor certified by the American Board of Plastic Surgery (ABPS), is most suited for performing cosmetic surgery, particularly for procedures such as liposuction, tummy tuck, or breast augmentation. Facial plastic surgery may be performed by an ABPS board certified plastic surgeon or an Otolaryngologist (also known as ENT, Ear Nose & Throat specialist) who is certified by the American Board of Otolaryngology. (“Avoid Bad Plastic Surgery,” 2007)
Patients
Almost anyone is a candidate for cosmetic surgery as is reflected in the large numbers of such surgeries being currently performed. Statistics released by the American Society for Aesthetic Plastic Surgery (ASAPS) show that in the United States alone, 11.5 million cosmetic surgical and non-surgical procedures were performed in 2005, which is a staggering 444% increase in the overall number of cosmetic procedures since 1997. (“Cosmetic Plastic Surgery Research,” 2006). At the same time, people with health conditions such as diabetes, hypertension, lung disease, heart disease, high cholesterol, arthritis, and emphysema, or those who are malnourished, severely depressed, obese and/or smokers are not generally good candidates for cosmetic surgery. On the other hand, good candidates for cosmetic surgery are those who are close (within 30%) to their ideal weight, are non-smokers, emotionally stable, exhibit low stress, exercise regularly and maintain a healthy lifestyle. (“Who is a Good Candidate?” n.d.)
Since women are usually much more concerned about their physical appearance as compared to men, statistics show that most cosmetic surgeries are requested by women. For example, according to the American Society for Aesthetic Plastic Surgery (ASAPS), 91% of all cosmetic procedures carried out in 2005 in the United States were performed on women while only 9% were carried out on men. (“Cosmetic Plastic Surgery Research,” 2006)
Reasons for Cosmetic Surgery
Reasons for carrying out cosmetic surgery vary considerably as each individual may have his/her own deeply personal reason for deciding to change their appearance. However, majority of people undergo cosmetic surgery to look younger or to change a physical feature of their body they do not like.
The need to look younger is not a new phenomenon. Human beings in most societies have always strived to look younger and have resorted to efforts such as dyeing their grey hair to drive away the years since ages. The present day Western society has become even more youth worshipping than before. The ageing baby boomer population in most Western nations including the United States is more health-conscious than earlier generations and has a greater need for wanting to look younger in a “youth-worshipping” culture. The advancement in medical technology in recent times and the increase in disposal incomes has made it possible for more people to choose cosmetic surgery as an option. The media, too, has contributed to the upsurge in cosmetic surgery as more and more TV programs, fashion magazines, and websites advertise the virtues of and impart information about cosmetic surgery.
Most people who undergo cosmetic surgery expect to achieve greater self-confidence and a sense of well-being as a result of the procedure. Some achieve their objective, while others are disappointed because cosmetic surgery is not a “cure-all” for psychological problems. This is mainly because some people choose cosmetic surgery for the wrong reasons and have unrealistic expectations. The “wrong reasons” can be the expectation to overcome a personal problem such as serious difficulties in marriage, expecting the surgery to change one’s life, or wanting to look like another person by altering one’s appearance. The “right reasons” for seeking cosmetic surgery are self-motivation, i.e., doing it for oneself rather than for someone else, and having a realistic expectation from the procedure. (Grayson, 2003)
Another major reason for the increasing trend towards cosmetic surgery is the intense competition in the business world and the bias against older people in the workplace: the widespread perception that an older person is less updated and less efficient in getting a job done. Hence, more and more people, including men have started to turn to cosmetic surgery in an effort to remain young-looking. Moreover, a more stressful lifestyle often leads to eating disorders resulting in obesity. Cosmetic surgical procedures such as liposuction are, therefore, being increasingly used to fight obesity.
Procedures
There are a vast number of surgical and non-surgical cosmetic procedures being performed currently. While a majority of the surgical procedures is requested by women, cosmetic surgery is rapidly gaining popularity among men as well.
Five Cosmetic Surgeries for Men
The top five cosmetic surgeries for men are: liposuction, rhinoplasty, eye-lid surgery, male breast reduction, and facelift.
1. Liposuction: Liposuction is the number one cosmetic surgery procedure for men. According to the ASAPS, a total of 52,543 liposuction procedures were performed in the U.S. On men in 2005 (“Cosmetic Plastic Surgery Research,” 2006).
Although it is possible to remove fat from almost any area of the body through this procedure, the three most popular areas for liposuction in men are the neck, abdomen and loin (love handle area). The fat beneath the skin has two layers: deep and superficial. The deep layer can be removed using the traditional liposuction technique, while the superficial layer, which is denser and contained within pockets of fibrous bands, is difficult to remove with traditional liposuction. Removal of the superficial layer is usually done with ultrasonic liposuction. (Levine, n.d.)
2. Rhinoplasty: Rhinoplasty is the second most common cosmetic surgical procedure performed on men and the ASAPS statistics reveal that a total of 45,945 such procedures were performed on men in the U.S. during 2005 (“Cosmetic Plastic Surgery Research,” 2006). The surgery involves reshaping of the nose by reducing or increasing size, removing hump, changing shape of tip or bridge, narrowing span of nostrils, or changing angle between nose and upper lip. (“Cosmetic Surgery: Procedures at a Glance,” 2007) There is not much difference between the rhinoplasty procedures for men and women, except that in harmony with the facial features of men, it is generally preferable to have a stronger, slightly longer nose.
3. Blepharoplasy (Eye-lid Surgery): It is the third most frequent cosmetic surgery in men with 33,369 such procedures being performed in the U.S. In 2005. (“Cosmetic Plastic Surgery Research,” 2006) the procedure involves correction of drooping upper eyelids and puffy bags below the eyes by removing excess fat, skin, and muscle. There is not much difference between blepharoplasy performed for men and women and the removal of saggy eyelids and puffiness underneath the eyes significantly reduces a prominent visible effect of aging.
4. Male Breast Reduction (or Gynecomastia): The 4th most popular cosmetic surgery for men with 17,730 procedures performed in the U.S. In 2005 (Ibid). It involves the reduction of enlarged, female-like breast in men using liposuction and/or cutting out excess glandular tissue. (“Cosmetic Surgery: Procedures at a Glance,” 2007)
5. Facelift (Rhytidectomy): It is the 5th most popular cosmetic procedure for men, performed 13,041 times in the U.S. during 2005 (“Cosmetic Plastic Surgery Research,” 2006). The Facelift procedure smoothes out the loose skin on the face and neck, tightens underlying tissues, and removes excess fat. As a result, the skin appears firmer and fresher.
Five Cosmetic Surgeries for Women
The top five cosmetic surgeries for women are: liposuction, breast augmentation, eye-lid surgery, tummy tuck, and breast reduction.
1. Liposuction: Just as for men, liposuction is also the number one cosmetic surgery procedure among women. According to AASPS, as many as 402,946 liposuctions were performed in the U.S. On women in 2005. The liposuction procedure is similar in men and women except that women generally have softer, less fibrous fat than men and it is easier to perform the procedure on them. Also the fat deposits in women are concentrated mainly on the hips, buttocks and upper thighs.
2. Breast Augmentation: The 2nd most common cosmetic surgery in women was performed 364,610 times during 2005 in the U.S. (“Cosmetic Plastic Surgery Research,” 2006). The procedure is, understandably, peculiar to women enhancement in the size of breasts using inflatable implants filled with silicone gel or saline.
3. Eye-lid Surgery (Blepharoplasy): ASAPS data shows that eye-lid surgery was performed 198,099 times in women across the U.S. In 2005. The procedure is similar in men and women, i.e., involves correction of drooping upper eyelids and puffy bags below the eyes by removing excess fat, skin, and muscle.
4. Tummy Tuck (Abdominoplasty): The 4th most popular cosmetic surgery in women was performed 164,073 times in the U.S. In 2005 (Ibid). Abdominoplasty is a major surgical procedure involving removal of excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. The surgery is particularly helpful to women who, through multiple pregnancies, have stretched their abdominal muscles and skin beyond the point where they can return to normal. (“Tummy Tuck (Abdominoplasty),” 2007)
5. Breast Reduction (Mammaplasty): Breast reduction in women, performed 160,531 times in 2005, closely follows tummy tuck as the 5th most popular cosmetic surgery procedure in the United States. It is directed at women with very large, pendulous breasts who are extremely self-conscious or may be experiencing other medical problems because of their large breasts. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer — the goal being to give the woman smaller, and better-shaped breasts in proportion with the rest of her body. (“Breast Reduction,” 2007)
Frequency of Cosmetic Procedures by Age Group
Cosmetic surgery includes surgical as well as non-surgical procedures that are performed on people of all ages. In addition to the most popular surgical procedures discussed above, the most frequently performed “non-surgical” procedures include Botox injections (for removing frown lines), laser hair removal, Hylaform injection (for wrinkle removal), Microdermabrasion (for removing fine wrinkles and unwanted skin pigmentation), and Chemical Peel (for removing skin-blemishes). According to the American Society for Aesthetic Plastic Surgery (ASAPS), out of the total 11.5 million cosmetic surgical and non-surgical procedures performed in the United States in 2005, the majority, i.e., 5.3 million procedures (or 47% of the total) were performed on people in the age-group of 35 to 50 years; the age group of 51 to 64 accounted for 23% (or 2.7 million) procedures; while another 2.7 million procedures (24%) were performed on patient’s in the 19 to 34 age-group. The age-group of 65-year and older accounted for 530,139 procedures (or 4% of the total), and another 174,851 procedures (2% of the total) were performed on younger people aged 18 years or less (“Cosmetic Plastic Surgery Research,” 2006).
The top surgical procedures for different age groups were as under: liposuction (Ages 35-50), eyelid surgery (51-64), breast augmentation (19-34), eyelid surgery (65 and over), and rhinoplasty (18 and under). The top non-surgical procedures for the same age-groups were Botox, Botox, Laser Hair Removal, Botox, and Laser Hair Removal respectively.
The Most Common Patient Complications
Significant advancement in medical and Cosmetic Surgical technologies in recent times has greatly reduced risks and complications previously associated with cosmetic surgery. However, every surgery carries a measure of risk. Similarly, a number of complications in cosmetic surgery still remain, some of which are discussed below:
Anesthesia / Sedation
Anesthesia and sedation used during surgeries sometimes cause serious complications. This kind of complication is not peculiar to cosmetic surgery alone but may occur during cosmetic surgeries especially if general anesthesia is used. Patients who have heart trouble, lung disease or are overweight are at greater risk of complications due to anesthesia. Complications associated with anesthesia include airway obstruction, blood clots, malignant hyperthermia, brain damage, heart attack, nerve damage, stroke, and temporary paralysis. (Cosmetic Plastic Surgery Basics, 2007) for example, the drugs used in anesthesia can sometimes cause spasms in the vocal cords resulting in blockage of the airways; temporary paralysis may occur if muscle relaxants have not fully worn off after surgery, or brain damage can occur if blood circulation is depressed to dangerous levels during surgery while under sedation. Malignant hyperthermia occurs when the body temperature, blood pressure and heart rate all rise to hyperactive levels (Ibid.). Some of the complications of anesthesia / sedation are so serious that they can even lead to death if not recognized and treated promptly.
Infection
The risk of infection in cosmetic surgery is low but quite serious when it does occur. At greater risk are people who smoke, take steroids or have certain vascular conditions. It is also linked to the type of surgery involved — the risk for infection being greater in surgeries that last longer or ones in which the patient loses more blood (Ibid.).
Most infections are caused by the patient’s “own” germs that normally live on our skins or in our guts without causing harm. During some of the cosmetic surgical procedures, these germs gain access to deeper tissues. In most cases, the body’s immune system is able to destroy them before they can cause harm, but sometimes the organisms succeed in overwhelming the body’s defenses, causing infection (Risks, 2007).
The telltale signs of such infection are swelling, redness and tenderness, which is sometimes accompanied by pus-like drainage from the wound and/or fever. Infections are more likely to occur in surgeries of areas that have a high bacterial count such as the abdomen and groin as compared to surgery of areas that have a richer blood supply such as the face and scalp. Chances of infection during cosmetic surgeries are reduced, though marginally, by the prophylactic use of antibiotics before surgery. Treatment of post-operative infection consists of wound drainage and treatment with appropriate antibiotics after performing culture tests. (Ibid.)
Bleeding
Bleeding that occurs during cosmetic a surgical procedure is easily controlled in most cases. However, sometimes significant bleeding may resume post-operatively. Such bleeding may collect in the areas between tissues created during cosmetic surgery and result in the development of a firm, tense clot within the tissues, known as hematoma. The hematoma or the clot usually causes significant pain and may be accompanied by hard swelling and discoloration in the area (Risks, 2007).
The chances for post-operative bleeding are relatively high in patients who have high blood pressure or clotting disorders, are aspirin or excessive alcohol users. Premature resumption of strenuous activities after the surgery can also cause bleeding. In case of post-operative bleeding and formation of clots, re-opening of the wound or re-surgery is usually required for removal of the clots. (Ibid)
Body Rejection
Some cosmetic surgery procedures such as breast augmentation or facial uplifts may involve the introduction of a foreign body inside a patient’s body. This could consist of implants used in breast augmentation, or chin, cheek or nose implants used to improve face profiles. Although inert material that is compatible with human tissue is normally used for cosmetic implants to eliminate the chances of body rejection, on rare occasions, a patient’s body is unable to cope with the introduction of a foreign body and results in rejection of the implanted body.
When such rejection is suspected, characterized by severe infection in the patient, the patient has to be put on immunosuppressive drugs and the implant has to be removed.
The Most Common Doctor Mistakes
Despite the great improvements in cosmetic surgery techniques in recent decades, mistakes continue to be made by doctors during such surgeries prompting legal malpractice cases against doctors and frequent stories of cosmetic surgeries gone horribly wrong. Some of these patient testimonials based on real life stories are discussed below:
Donni-Jay De-Ville’s Experience with Cosmetic Surgery
Donni-Jay, a belly dancer, underwent a tummy-tuck surgery at the age of 26 to remedy loose skin over her lower tummy. A short time later, she gained considerable weight and the doctors discovered that an under-active thyroid was the cause of her weight-gain. Liposuction was advised and performed. She was informed that fat removal as a result of the liposuction would be permanent, which was not the case. Just two years later, Donni-Jay had regained her pre-surgery weight despite a strict regimen of low-fat diet. She had to have another liposuction operation.
Some years later, Donni decided to have another liposuction performed on her slightly puffy lower eyelids. She later realized that her left eye was almost exactly the same as it was before the surgery, as the surgeon had not removed enough fat from the eyelid. Moreover, Donni thinks she probably never needed the liposuction in the first place but the surgeons did not advise her against the operation. She is convinced by her experience with cosmetic surgery that surgeons “will take a patient on, even if the surgery is unnecessary.” (De-Ville, 2004)
Botched Overseas Surgeries
2006 report in “The Age,” Australia issues a warning about how “cheap” cosmetic surgery overseas can go wrong. It gives the example of a young Australian woman who returned with a two-centimeter bald strip across the top of her scalp after a botched eyebrow-lift surgery in Thailand. It also narrates the story of another woman who returned home from an overseas breast enlargement procedure with no cleavage as a result of a surgical error. Both had to have the mistakes corrected through further plastic surgery in Australia. (“Warnings on Plastic Surgery Mistakes,” 2006) the report further informs that a number of Australian surgeons were currently involved in treating complications of cheap overseas cosmetic surgery such as “hideous scarring, infections in breast implants and failed tummy tuck.” (Ibid.)
Beware of Bargain Surgeries
An article in Click2 Houston.com, titled “Plastic Surgery Mistakes Leave Patients Scarred,” warns about the dangers of looking for bargains while contemplating cosmetic surgery. It quotes the experience of Gina Hern, a Houston-based professional makeup artist and spa owner who got breast implants at a clinic in Mexico for just $2,000 as compared to the average price of $6,000-8000 for a similar implant in the U.S. However, the results of her “cheap” implant were far from satisfactory: the implants turned rock hard; a “terrible indentation” developed where the implant was misplaced; they were lop-sided and pointed in different directions, and one of the implants began to poke through her skin. In order to repair the damage, Hern had to undergo several surgeries, which cost her $10,000 more. The article also narrates the example of another woman, “Dixie,” whose cosmetic surgery in Mexico left her with permanent nerve damage to her face, and a tummy tuck that resulted in her belly button shifting about an inch and a half off-center. To emphasize that not all botched surgeries take place overseas, the article also gives the example of a woman, Latonya Robinson, whose bad tummy tuck operation by a local doctor left her without a belly button! (Plastic Surgery Mistakes…” 2006)
How to Prevent Cosmetic Surgery Mistakes
Since cosmetic surgery is usually elective, i.e., it is chosen by a patient to look better rather than it being a life or death matter, the patient should be extra careful while choosing to have surgery in order to avoid the mistakes associated with it. Some of the steps that patients and doctors can take collectively to prevent or minimize the chances of mistakes are:
Choosing the Right Surgeon
Many doctors in the U.S. offer cosmetic surgery without being board-certified or without having any training in cosmetic surgery. It is, therefore, important for a patient to choose a surgeon who is certified by the American Board of Plastic Surgery (ABPS) as a plastic surgeon. Although this would not be a 100% guarantee against mistakes, it would certainly reduce the odds against it as an ABPS certified surgeon has to satisfy strict criteria for the certification, i.e., at least 5 to 6 years of approved surgical training, including a 2 to 3-year residency in plastic surgery; requirement of being in practice for at least 2 years and having passed comprehensive written and oral exams in plastic surgery (Begoun, 2005).
Choosing Cosmetic Surgery for the Right Reasons
Before deciding to go for cosmetic surgery, one must make sure that it is being done for the right reasons. Many people decide on cosmetic surgery just because their favorite celebrities are having their looks altered or because they want to look like someone else. These are certainly not the right reasons for deciding on cosmetic surgery. It is, therefore, important to have realistic expectations from the surgery: it would certainly not make one look like someone else. While the right kind of cosmetic surgery does make one look younger or more beautiful, it is also important to realize its downside. It can give one an expressionless zombie look, or get an undesired fixed expression by having their faces cut and pulled too tight. One only has to look as far as Michael Jackson’s face to realize the downside of excessive or inappropriate cosmetic surgery. However, it is not just the responsibility of the patient for making the right choice in cosmetic surgery. The doctors too have an equal obligation. They must not give unrealistically high expectations to the prospective patients or gloss over the risks involved in cosmetic surgery.
References
Avoid Bad Plastic Surgery.” (2007). Implant Forum. Retrieved on February 6, 2007 at http://www.implantforum.com/doc-research.html
Begoun, P. (2005). “Paula’s Choice: Cosmetic Surgery.” Cosmetic Cop. Retrieved on February 6, 2007 at http://www.cosmeticscop.com/learn/article.asp?PAGETYPE=ART&REFER=SKIN&ID=16
Breast Reduction.” 2007. American Society of Plastic Surgeons. Retrieved on February 6, 2007 at http://www.plasticsurgery.org/patients_consumers/procedures/ReductionMammaplasty.cfm?CFID=70891386&CFTOKEN=28865053
Cosmetic Plastic Surgery Basics.” (2007). Smart Plastic Surgery. Retrieved on February 6, 2007 at http://www.smartplasticsurgery.com/surgery/risks.html
Cosmetic Plastic Surgery Research.” (2006). Cosmetic Plastic Surgery Statistics. Retrieved on February 6, 2007 at http://www.cosmeticplasticsurgerystatistics.com/statistics.html
Cosmetic Surgery: Procedures at a Glance.” (2007). American Society of Plastic Surgeons. Retrieved on February 6, 2007 at http://www.plasticsurgery.org/patients_consumers/procedures/CosmeticPlasticSurgery.cfm
De-Ville, D.J. (2004). “Cosmetic Surgery Dangers!” Author’s Den. Retrieved on February 6, 2007 at http://www.authorsden.com/visit/viewarticle.asp?AuthorID=17759&id=15273
Grayson, C.E. (2003). “Choosing Cosmetic Surgery.” Medicine Net.com. Retrieved on February 6, 2007 at http://www.medicinenet.com/script/main/art.asp?articlekey=43228
Levine, J. (n.d.) “Liposuction for Men.” Ask Men. Retrieved on February 6, 2007 at http://www.askmen.com/sports/health/13_mens_health.html
Plastic Surgery Mistakes Leave Patients Scarred.” (2006). Click 2 Houston.com. Retrieved on February 6, 2007 at http://www.click2houston.com/health/6842979/detail.html
Risks.” (2007). Godfrey & Godfrey: New York Plastic Surgery Associates. Retrieved on February 6, 2007 at http://www.nypsa.com/risks.html
Tummy Tuck (Abdominoplasty).” 2007. American Society of Plastic Surgeons. Retrieved on February 6, 2007 at http://www.plasticsurgery.org/patients_consumers/procedures/Abdominoplasty.cfm
Warnings on Plastic Surgery Mistakes.” (2006). The Age. Retrieved on February 6, 2007 at http://www.theage.com.au/news/National/Warnings-on-plastic-surgery-mistakes/2006/01/17/1137466979953.html
Who is a good candidate?” (n.d.) Smart Plastic Surgery. Retrieved on February 6, 2007 at http://www.smartplasticsurgery.com/basics.html#GC
Facial Plastic Surgery includes cosmetic procedures such as Rhinoplasty (re-shaping of nose), Blepharoplasy (eye lid surgery), Rhytidectomy (face-lift), chin augmentation, Octoplasty (reshaping of ear), or chemical peel (removal of scars or wrinkles with chemicals)
Wanting to look exactly like a celebrity is a classic example of unrealistic attitudes
Liposuction is a surgical procedure in which fat deposits are removed with the help of a tube and vacuum device.
Ultrasonic liposuction a new technique in which an ultrasound probe is inserted beneath the skin to liquefy the fat before it is suctioned
Cosmetic Surgery
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