Getting the Curves You Crave With Plastic Surgery

Michelangelo's David has held his valiant pose in Florence, Italy, for hundreds of years, unmoved by critics' notions that his stone — and sling-holding hands are disproportionately large for the rest of his body.

The marble sculpture of the Goliath-slaying hero is one of the esteemed masterpieces of all time, not likely to ever be rechiseled to correct its odd proportions. Modern men and women, though, are refusing to stand still for their own out-of-proportion body parts. Instead they are turning to plastic surgeons more and more to resculpt their parts to the ideal size.

Yes, thinner thighs in thirty days might be achievable with huffing and puffing, but like it or not, the exerciser can expect to see a whittling down, too, of the arms that might already be too thin or the breasts that are a pleasing size to begin with.

With all the health benefits of a vigorous aerobic workout, "working out isn't the cure-all for body woes," acknowledges Irv Dickstein, manager of a health club in Olney, Md. "There are two things working out can't do: spot-reduce and enlarge the breasts."

Liposuction: No. 1 on the Hit Parade

It comes as no surprise to Dickstein, then, that liposuction and breast augmentation are the one-two most popular plastic surgeries in the United States.

Liposuction comes in first, with about 231,000 Americans turning to the fat-vacuuming procedure in 1999 alone, according to the American Society of Plastic Surgeons. About 167,000 women had breast implants in that year, according to the plastic surgery trade group. The costs of these two procedures vary by state; insurers do not reimburse expenses for cosmetic operations.

These two body-contouring techniques and other, less common procedures — tummy tucks and breast reductions, for example — aim to reshape the body's tissues to give people the look they long for.

Mother Nature gave Elise Baldwin (not her real name) some body characteristics that the 32-year-old hair colorist longed to de-emphasize: "large hips and fat knees," and "after having three kids, fat on my belly that I couldn't get rid of."

Getting the Curves You Crave With Plastic Surgery (<i>cont'd</i>)

When she came to the United States from France a few years ago, Elise started making enough money to afford plastic surgery. "I cared about my looks," she says, so I said to myself, "Why not?" Her first procedure: liposuction in 1997.

Also known as lipoplasty or suction lipectomy, liposuction removes fat deposits from specific areas of the body. In women, the hips, thighs, abdomen, legs, and buttocks are among the most common target areas.

Men — who, like Americans in general, undergo liposuction more than any other plastic surgery — are most often looking to dissolve their love handles. Liposuction can also remove fat from the abdomen, knees, upper arms, chin, cheeks and neck.

New Liposuction Techniques

In liposuction, the plastic surgeon inserts a narrow tube through the skin via a tiny incision and pushes and pulls the tube through the fat layer deep beneath the skin to break up the cells. An attached vacuum unit sucks out the fat.

New liposuction techniques offer variations on the standard vacuum technique that are sometimes used to aid contouring:

  • Ultrasound-assisted lipoplasty, or UAL: The tube inserted through the skin produces ultrasonic energy, which liquefies the fat by exploding the fat cells' walls. The fat is then removed by traditional liposuction.
  • Tumescent and Superwet techniques: a medicated mixture of salt solution, a local anesthetic, and adrenaline to contract the blood vessels is injected into the fatty area before the fat is removed.

Sucking Out 10 Pounds of Fat

The amount of fat taken out from the body is dictated by the patient's body type and the look they're striving for. Fitness club manager Dickstein knows body builders who opted for liposuction "to get rid of that last one-quarter inch of fat they couldn't diet down from."

Getting the Curves You Crave With Plastic Surgery (<i>cont'd</i>)

It's not unusual, on the other hand, for liposuction to take up to 10 pounds of fat from a person, says Scott Spear, M.D., professor and chief of plastic surgery at Georgetown University in Washington, D.C.

Experts tend to agree it's best to be at a "normal" weight when getting liposuction, and to rely on the procedure to get rid of stubborn fat pouches that have resisted dieting attempts. But Spear, for one, doesn't get preachy on his patients:

"The better the person's condition, the better the surgery will look. But I don't tell people they have to get in great shape first. If they come to me, they want to know what I can do for them, not what they should be doing."

Spear acknowledges the limits of liposuction's power, however. Liposuction "can make a fat person less fat, but if you're 50 pounds overweight, it probably won't have that much of an effect."

Down Sides of Liposuction in Perspective

With a properly trained surgeon and an adequately equipped operating facility — be it a hospital, outpatient surgery center, or a surgeon's accredited office-based facility — liposuction is generally safe, according to the American Society of Plastic Surgeons.

But complications, though rare, can occur with any of the liposuction techniques and should be explained by the plastic surgeon. Risks include infection, excessive bleeding, formation of blood clots, nerve damage, and excessive fluid loss.

Death from liposuction is extremely rare. Liposuction is not recommended for those with complicated diabetes, poor circulation, significant heart or lung disease, or those with recent surgery in the region to be suctioned.

Even without such complications, Spear says, "As a rule, the bigger the procedure, the more risk there's going to be."

For one thing, when a large amount of fat is being removed, patients typically get general anesthesia, which can carry greater risks than local numbing types of anesthesia often used for more limited liposuction.

Getting the Curves You Crave With Plastic Surgery (<i>cont'd</i>)

Spear views every surgery as risky enough to warrant precautions. "We take the risks very seriously and take steps to reduce them. That may mean doing only a certain amount of liposuction at one time, or having a patient spend a night or two in the hospital after surgery."

Liposuction Patient Say It's "Worth It"

Even Elise's typical spot reductions, while not requiring a hospital stay or any other special precautions, left her feeling stiff, sore and numb in the operated areas. These symptoms and pain, burning, swelling, and bleeding are common in the days or weeks following surgery.

Elise says her surgery was "worth it," though she is not entirely satisfied with her plastic surgeon's work. "Now I can dress more easily, though I don't look perfect in a bathing suit."

The surgery won't prevent her from gaining weight; liposuction removes a certain number of fat cells, but the remaining cells can still grow bigger. But Elise's aerobics regimen should help maintain her look.

It's a look she enhanced again earlier this year with a different type of plastic surgery — this time, a breast augmentation.

Breast Implants

Having smoothed out the contour in the bottom half of her body with liposuction, Elise decided that she wanted her top to be more in proportion. It's a very common reason for getting implants, says board-certified plastic surgeon Diane Gerber, M.D., who has performed hundreds of breast augmentations in her Chicago office.

"Most people just want their clothing to fit more uniformly, to get the same size top and bottom. Sometimes they want to look perkier, larger, to replace what they lost during pregnancy."

It's about improving body image, Gerber continues. "That's a very important thing for most people. How you perceive yourself has a lot to do with how you relate to others, whether they're people you're intimate with or just deal with on a day-to-day basis."

Getting breast implants was a "much bigger deal" than liposuction for Elise because, she explains, "Liposuction takes something out of your body; implants put something in."

Getting the Curves You Crave With Plastic Surgery (<i>cont'd</i>)

The implants put into Elise's body were filled with saline and turned her A-cup breasts into full B's. (Saline is what all new cosmetic breast implants are filled with since 1992, when the Food and Drug Administration banned silicone gel-filled ones for most cosmetic uses based on reports that silicone gel could cause serious diseases if it leaked into the body.)

Having given long, serious consideration to whether she should get implants, Elise's fellow hair stylist and friend Claire Simmons (not her real name) went to the doctor with Elise and had the operation, too.

"I always wished I could have more," says the 32-year-old woman, petite at 5 feet 2 inches and 110 pounds. "But I thought 'no way.' I was afraid and was worried about what others would think. Then I got to an age where I was secure enough to do it, after considering the good and the bad."

The up side of upgrading from her nature-made A cup to a small B was the prospect of easily fitting into bras and bathing suits. "Before, bathing suit tops were empty, and even an A bra was too big. There would be just one pretty bra that fit, and I would have to stock up because I was afraid they would discontinue it."

The risks? Rupture, hardening, shifting in position, pain, numbness in the nipple or breast tissue, or infection. Breast implants can also interfere with breast-feeding and breast cancer detection through mammograms. Scars fade over time, while never disappearing entirely.

Claire says she has none of the bothersome side effects and is content with her new B breasts. "It didn't change my life, but it made shopping more fun. I can wear strapless dresses now." For Elise's part, she says, "I'm happy, but I feel a lot of wrinkles. I guess it's difficult to make them perfect."

It's those who expect perfect results, and a life changed by aesthetic operations, who tend to be dissatisfied with the results of their plastic surgery, Gerber says. Liposuction, breast implants, or other contouring procedures might not turn you into a statuesque supermodel like Cindy Crawford or Naomi Campbell. But cosmetic surgery does hold the promise of creating a shapelier you.