“We all look good for our age, except for our necks,” writes Nora Ephron in her book I Feel Bad About My Neck. Is it any wonder Ephron’s book went straight to the best-seller list upon its release last year? Couldn’t most every one of us say, “We look good, except for (fill in the blank)”?
While the nervous Nellies among us (like me) would rather learn to live with our sagging jowls than risk going under the knife, it doesn’t take a rocket scientist to know that such conservatism is fast losing ground. Thanks partly to the aging of the baby boomers and thanks partly to the Dr. 90210s of the world, the popularity of cosmetic surgery may soon outpace that of the potato chip—and that’s saying a lot. In 2005, more than 2 million Americans elected to undergo cosmetic surgery, according to the American Society for Aesthetic Plastic Surgery, representing a whopping 119 percent increase since 1997.
It also is becoming more mainstream.
“It isn’t just the rich and famous [who are getting cosmetic surgery]—it’s everyone,” notes Thomas Whetzel, M.D., a plastic surgeon and professor of surgery at UC Davis Medical Center. Whetzel believes the demand for cosmetic surgery will continue to grow because today’s consumers are less willing to accept what is. “If they have a little extra skin from childbirth that’s hanging from their abdomen, they’ll say, ‘Oh, I need to have that cut off,’” he says. “The previous generation probably wouldn’t have even thought about it.”
For those who are thinking about it, here’s a look at 10 hot topics—from procedures to sociological trends—straight from the lips of local plastic surgeons.
1. Lipo is still No. 1. Holding the No. 1 spot is liposuction, the most popular cosmetic surgery in the United States for 10 years running. Whether performed alone or in conjunction with other procedures, the goal of liposuction is plain and simple: to get rid of unwanted fat. (No wonder it appeals to so many.)
“Liposuction is one of the most common procedures I do, simply because it’s so popular,” says plastic surgeon Wayne Yamahata, M.D., of the Plastic Surgery Center in Sacramento. The trend, says Yamahata, is to use finer cannulas (flexible tubes) to extract the fat, which provides more control than the larger cannulas used in years past. “When we started doing lipo 20 years ago, cannulas were much larger and would take fat out very quickly,” he explains. “The problem was the fat came out so fast, you couldn’t control it, so bumpiness and rippling of the skin was more of a problem.” Slowing things down, he says, allows the surgeon to “sculpt” a more aesthetically appealing look and provide a better result.
Liposuction works best on areas in which fat is soft and loose, such as thighs, abdomen and buttocks, notes Yamahata, but doesn’t work so well in areas where fat is fibrous, such as the back or breasts. For such stubborn areas, some surgeons are now using ultrasound-assisted liposuction (one of the latest is LipoSelection by Vaser), which works by melting the fat before extracting it. But Yamahata is erring on the side of caution. “When you use the ultrasound machine, you can dissolve things other than the fat, such as blood vessels and nerves,” he says. Burning the skin is another potential side effect, which, for him, is just one more reason not to do it. “I’ll keep trying the new machines,” he says, “but I’m not using it until the technology is better.”
2. Body lifts are booming. One of the fastest-growing areas of cosmetic surgery, body lifts are used to reshape and contour the body following massive weight loss. Its popularity parallels the unprecedented growth of bariatric (weight loss) surgeries being performed in the United States, according to plastic surgeon Michael S. Wong, M.D., of UC Davis Medical Center, director of the Body Contouring After Weight Loss program. For many patients, says Wong, body lift surgery is the final step of a journey that begins with bariatric surgery. “A lot of times, they come to plastic surgery to remove the final vestiges of their former lives of being heavy,” he says. “When they come to me, they might say, ‘I’ve lost 160 pounds, but to me, I still look and feel fat.’ So we can give people a new lease on life.”
Most of his patients have lost 100 or more pounds, says Wong, resulting in significant skin excess. “The skin envelope that once accommodated 300 pounds is now on a frame carrying only 160 pounds, so there’s a lot of excess,” he explains. Because the excess skin is not only in the front, but all the way around the body, says Wong, circumferential surgeries such as body lifts offer a better solution for these patients than, say, a tummy tuck. When a patient wants “everything done” including an upper body lift (breasts, lateral chest, back), a lower body lift (abdomen, outer thighs and buttocks) and extremities (upper arms and inner thighs), Wong typically performs the surgeries in three stages, partly for reasons of patient safety. “We don’t want to keep them under anesthesia too long,” he explains. Although significant scarring is inevitable, Wong finds that this particular group of patients tends to be more accepting of extensive scars because the surgery so vastly improves their quality of life.
3. Thread lifts: Yay or nay? For those who find a traditional face lift too scary, the less invasive, much-talked-about thread lift has a natural pull. But a natural pull is what you probably won’t get from a thread lift, warns Roseville facial plastic and reconstructive surgeon Kenneth Toft, M.D., who, ironically enough, notes he was the first in the Sacramento area to perform one. “The problem is that the thread is somewhat stiff—like fishing thread—so when patients smile and the cheek lifts, the thread can bow out and people can see it,” he says. By putting the threads much deeper, Toft says, he’s been able to solve the visibility issue, but the technique is so new that no one knows how long results will last. “It could be four months, it could be four years.”
Although the idea of using suspension sutures (threads) to elevate sagging skin is conceptually sound, says Toft, the technology, in his opinion, just isn’t there yet. And though it is far less invasive than a standard face lift, a thread lift carries many of the same risks, including nerve damage, hematoma (collection of blood under the skin) and asymmetry.
4. Brow lifts are getting better. A brow lift used to mean getting slit from ear to ear across the top of your head, but not anymore. The endoscopic brow lift—which requires a few small incisions and enjoys a shorter recovery time—is fast becoming the technique of choice. “The brow lift really has a come a long way,” says Tyrone Glover, M.D., an ophthalmic plastic and reconstructive surgeon for Kaiser Permanente in Sacramento, who notes that the traditional coronal brow lift is still a better choice for certain patients, such as those with significant brow drooping. “The older you are, the more descent you have, so you’ll get a better result if you do the surgery when you’re younger,” says Glover, whose patients are mostly women in their 50s who want to look “alert and refreshed.” Brow lifts are frequently performed in conjunction with face lifts and/or eyelid surgery, especially when patients have significant skin overhang in the upper eyelids.
5. Fill ’er up with fat. When 57-year-old Ginger Maxwell (not her real name) had a face lift 13 months ago, she also wanted to do something to plump up her upper lip. “I had thin lips to begin with,” she says. “But as I got older, my upper lip began to disappear.” Instead of using collagen or another injectable filler, Maxwell’s surgeon extracted a tiny amount of fat from his patient’s abdomen—just one example of the microfat grafting technique that is being used in a growing number of cosmetic-surgery scenarios. Fat repositioning is another trend, notes Glover, who frequently uses the technique with lower eyelid surgery (blepharoplasty). Instead of removing fat from underneath the eyes, Glover explains, surgeons are now repositioning it by moving it to the tear trough area. “We learned that if you remove too much fat, it can result in a hollow look,” he says. “Redistributing the fat is a way to retain the youthful fullness.” Another option, notes Toft, is to remove the under-eye fat and fill in the tear troughs with Restylane (hyaluronic acid)—an approach he has found to offer more consistent results.
6. The demographics are shifting. Although women are still winning the cosmetic surgery sweepstakes by a landslide, accounting for some 91 percent of those who underwent cosmetic procedures (surgical and nonsurgical) in 2005, a growing number of men are slowly trickling into the race. “It’s still a low percentage,” says Toft, “but I am seeing more men.” Most are motivated by a desire to compete in the workplace, notes Toft. “They’re often competing with younger guys in the business world and want to look less tired, more refreshed.” The demographics are shifting in other ways, too: Glover notes he’s seeing an increasing number of African-Americans and Hispanics—“ethnic groups you didn’t see as frequently in the past.” As for couples scheduling surgery together—a trend cited in a recent survey by the American Academy of Facial Plastic and Reconstructive Surgery—Sacramento couples aren’t exactly breaking any records, according to local surgeons.
7. Help for aging necks. In I Feel Bad About My Neck, Ephron laments that a neck lift can’t be performed without a face lift—that it’s “all one big ball of wax.” But according to Toft, a neck lift can be performed by itself, though the more common scenario is to combine the procedure with a face lift. “Very frequently, people’s necks go faster (age faster) than the rest of the face,” he says. During a neck lift, the sagging neck muscle (platysma) is tightened and excess skin and fat is removed, resulting in a taut, more youthful neckline. In minor cases, Toft says, a little liposuction under the chin will do the trick. But those whose necks have deteriorated into a “waddle” will probably need a full face lift (which includes a neck lift) for best results.
8. Silicone is back. The big news in breast augmentation is that silicone is back, giving patients an alternative to the saline implants that have been “the only game in town” for the past 14 years. Banned for general use in 1992 due to allegations linking silicone with connective-tissue diseases, the FDA lifted the moratorium in the United States in November 2006 after rigorous studies showed no evidence that the devices pose serious health risks. So why might a patient prefer silicone? “The benefits are that silicone implants feel much more natural, are much less palpable, and visible wrinkling is minimized as compared to saline,” says Roy Semlacher, M.D., a Carmichael plastic surgeon in private practice and director of plastic surgery at Mercy San Juan Hospital.
On the downside, notes Semlacher, silicone implants require larger incisions than do their saline counterparts and tend to be “silent” when they rupture—a concern that has prompted the FDA to recommend routine MRIs for patients with silicone implants. The FDA has also placed age restrictions on silicone implants for breast augmentation patients, who must be at least 22 years of age (for saline, the magic number is 18). But if you grow queasy at the thought of having any kind of foreign object installed in your body, there is hope: Fat grafting to the breast is gaining ground in some circles, according to Semlacher. “Breast augmentation with your own fat is something that’s emerging. But that’s really on the edge.”
9. It’s not in the closet anymore. When Elaine Orozco returned to work after having breast augmentation surgery, the reaction was “Can I see ’em? Can I touch ’em?” But that was OK by her. The way Orozco sees it, she’s got nothing to hide. “I was open about it,” says the 38-year-old Sacramentan, who now jokes about celebrating her “twins’ birthday” every October. Such candor is common among today’s cosmetic surgery patients, notes UCD’s Whetzel. “It certainly isn’t hidden anymore,” he says. “People will hold up their shirt and go, ‘Look.’”
10. The anti-trend trend. “Hot new things will always emerge on the scene,” notes Whetzel, “but you need to separate the truth from the hype.” Whetzel’s sentiments were echoed by so many surgeons interviewed for this article that it suggests there is an “anti-trend” trend under way. “Patients want all kinds of stuff they may not necessarily need,” he says. The glam factor of the “latest” or “newest” is designed to dazzle, but, as Whetzel says, patients would be well-advised to “go for the technique that would do you the most good, whether it’s older, newer—or nothing at all.” In brief: Just because it appeared on “Oprah” doesn’t mean it will work for you—so buyer beware.
Top Five Cosmetic Surgeries in the U.S. (2005)
2. Breast augmentation
3. Eyelid surgery
4. Tummy tuck
5. Breast lift
2. Rhinoplasty (nose reshaping)
3. Eyelid surgery
4. Breast reduction
5. Face lift
Source: American Society for Aesthetic Plastic Surgery
It’s a Family Affair
Roy Semlacher, M.D., asks that a spouse or significant other come to at least one of the surgery pre-op appointments—and there’s a good reason for that.
“There’s two parts to your cosmetic surgery experience: getting the surgery done and your support system,” says Semlacher. By coming to an appointment, Semlacher says, the other party will have a clearer understanding of what to expect during the post-op recovery process. Having a support system in place is especially critical if there are complications, notes Semlacher.
Ginger Maxwell, whose post-face lift complications included a hematoma, significant hair loss and a severe facial rash, can attest to that. “My mother stayed with me 24/7,” says Maxwell. “It was very trying for the family.”
Contemplating a little nip/tuck?
You are not alone. According to a 2006 survey by the American Academy of Cosmetic Surgery, nearly 20 percent of the American population aspires to undergo cosmetic surgery in their lifetime.
Three Women, Three Surgeries
They didn’t have to go under the knife—but they did. What motivated them? Are they satisfied with the results? What would they want others to know?
Here are the stories of three local women who candidly and graciously answered these questions—and more.
Elaine Orozco, 38
Surgery: Breast augmentation
Approximate cost: $4,000
Ginger Maxwell (not her real name), 57
Surgeries: Face lift, forehead lift, neck lift, upper eyelid reduction, fat grafting to upper lip, laser resurfacing
Approximate cost: $20,000
Alice Johnson (not her real name), 68
Surgery: Liposuction on stomach and lower back (“upper butt area”)
Approximate cost: $3,200
What motivated you to have cosmetic surgery?
Elaine: I had been a C cup in high school, but after having three children, I went down to a low B. I wasn’t filling out clothes and I wasn’t properly proportioned.
Ginger: I had a lot of loose skin across my cheeks, I had wrinkling and deep creases around my mouth, and my upper lip was disappearing. I felt like I looked about 10 years older than I was .
Alice: I’ve fought the weight battle since I was 6 years old. Even though I had kept my weight down fairly well for a long time, I still had quite a bit of weight across my lower back and in my stomach. No matter how much weight I lost, I couldn’t lose in those areas.
What were your hopes and expectations?
Elaine: I just wanted to get back what I had before. I was spending lots of money on water bras and push-up bras just to fill out my clothes.
Ginger: It wasn’t that I wanted to look younger than my age—I just wanted to look my own age. I was tired of looking tired.
Alice: I wanted to get rid of the fat in those stubborn areas and have a more well-proportioned body.
How did the surgery go? Was it painful? Were there complications?
Elaine: I have a very, very high pain tolerance—even when I had my children I tolerated it well, and I had them naturally. But the pain from breast surgery, on a scale of 1 to 10, was like a 10-plus. It was over in a few days, though. In a week, I was back at work and doing fine.
Ginger: It wasn’t painful, but I was very uncomfortable. My whole face turned black and blue from bruising, and it was beet red from the laser treatments. I developed a severe rash on my face and had to go in for special treatments. I also lost gobs of hair—they “forget” to tell you about that—and I developed a hematoma (collection of blood under the skin) along the left side of my cheek, which had to be drained every day. But I wasn’t even as concerned about the face as I was my lips, which were so monstrous and swollen that I couldn’t even open my mouth to eat. I was miserable—just miserable. I cried a lot.
Alice: There was no pain, but some discomfort. They went in through my navel, and it didn’t want to heal. It was open and oozing and not healing properly. That took a while, but for the most part I recovered quickly. In fact, the day after the surgery, I was feeling good enough to stop at Target on the way home and do a little shopping.
Were you happy with the results? Did you get what you wanted?
Elaine: I’m extremely happy with what I got. I’m more confident in the way I look in clothes, and it has raised my self-confidence. I never thought of myself as unattractive, but I feel more beautiful inside as well as outside. I think it’s one of the best decisions I’ve made for myself.
Ginger: I feel I look my age again and I look refreshed, so I’m happy now, though it was a very long healing process. I still have what I call the “laser screen” across my forehead, and I’m still numb in some spots, and I don’t know if that will change in time. (It’s been 13 months since her surgery.) But I think it looks natural, which is what I wanted.
Alice: I’m definitely happy with the results. I absolutely hated my body before. There was a lot of fat and sagging across my lower stomach that I could not get rid of, no matter how I tried. And it’s gone. For me, having the surgery has made a tremendous difference in my body image.
Is there anything you’d want prospective cosmetic-surgery patients to know?
Elaine: Do a lot of research, and be realistic about what you want and what can be achieved. If not, you won’t be happy with your outcome.
Ginger: This is major surgery, and you won’t heal overnight. You need to do your research so you are fully aware of what might happen to you. And give yourself more time off from work than you think you need. I was told I would be able to go back to work in three weeks, but I had to wait two more weeks, and it took about three months before I even started looking halfway normal.
Alice: Make sure your doctor explains everything thoroughly, including all the risks. And make sure you feel comfortable with the doctor. If you don’t, find someone else.
Face First—Feeling baffled by face-lift lingo such as minimal incision, deep plane and SMAS? Fuggedaboutit.
“Don’t get caught up in the names,” offers Kenneth Toft, M.D., a Roseville facial plastic and reconstructive surgeon. “That’s the marketing, and not everyone uses the same name for the same thing.”
Instead, ask your surgeon where the incisions (and resulting scars) will be, why this technique is being recommended for you and how much experience the surgeon has with the technique. As Toft notes, surgeons who perform a wide range of cosmetic surgeries may spend as little as 20 percent of their time on the face, so it may be advisable to choose a surgeon dedicated to facial plastic surgery.
“You need to be extra careful with the face because you can’t cover it up with clothes,” he reasons. “It’s right out there.”
Surgeons speak out—If they could send out just one message to prospective patients, what would it be? Here are some pearls of wisdom from local plastic surgeons.
“You get what you pay for. You’ve really got to do your research and know what you’re getting.”—Roy Semlacher, M.D., private practice, Carmichael
“Any kind of surgery has risks. People who watch ‘Extreme Makeover’ and similar shows may be getting an unrealistic impression, as these shows tend to minimize the fact that these are significant surgeries with real potential risks.”—Michael S. Wong, M.D., UC Davis Medical Center
“Go to someone who specializes in the procedure(s) you’re having done. Get multiple opinions. And educate yourself on the procedure—or, better yet, choose a doctor who will take the time to educate you.”—Kenneth Toft, M.D., private practice, Roseville
“Be skeptical of surgeons who try and talk you into more procedures than you asked for.”—Thomas Whetzel, M.D., UC Davis Medical Center
“Be careful not to pick a surgeon just because they have a big advertisement in the Sunday paper.”—Wayne Yamahata, M.D., Plastic Surgery Center
“Make sure you’re doing it (surgery) for yourself—not for your spouse, a boyfriend or anyone else.”—Tyrone Glover, M.D., Kaiser Permanente
Need more information about procedures or a referral to a qualified surgeon? The following resources may help.
American Society for Aesthetic Plastic Surgery
American Society of Plastic Surgeons
Cosmetic Surgery Network