Long before anyone thought to nip and tuck or even heard of a place called 90210, plastic surgery was a fascinating field of medicine. Plastic surgeons used their skills to help accident victims and children with birth defects or to cure diseases of the skin and soft tissues. Some of the results were remarkable, and it wasn't long before creative surgeons -- and sometimes more-creative patients -- started the trend toward plastic surgery for purely cosmetic reasons.
This article reviews some of the most common plastic surgical procedures, including what you need to know before considering one. For starters, you are certainly not alone. Cosmetic surgeries are becoming increasingly popular and increasingly accepted.
People often request cosmetic surgical procedures because they are unhappy with some aspect of their appearance. However, all surgeries leave scars. Plastic surgeons have a saying: "Shape for scars." Despite techniques that help conceal or minimize scarring, all of these procedures require accepting scars in the hope of obtaining a better shape. Also, however enticing the results may be, these are surgical procedures and should not be taken lightly. Still sound like a fair deal? Read on to learn about some of the most common cosmetic surgery procedures used today.
In cosmetic surgery, as in cardiology and other fields, the trend is toward less invasive approaches. Topical applications such as chemical facial peels, lasers and wrinkle creams are often effective supplements to surgery. Botox, a toxin made by botulism bacteria, is used to temporarily paralyze facial muscles that cause wrinkling. In areas of constant motion -- think smile lines around the eyes or frown lines in the center of the brow -- these muscles cause repetitive creases, which lead to permanent wrinkles.
Patients typically receive pretreatment with a prescription-strength cream to numb the skin, and Botox is administered with very small-gauge needles. The plastic surgeon uses knowledge of the anatomy of the facial muscles to systematically inject them with tiny amounts of Botox. This paralyzes the muscle for anywhere from 4 to 6 months, reducing the extent to which it can pull on the skin. While the treatments may make you less able to move your eyebrows to show the full extent of your surprise or anger, people still generally get the message. Botox causes a temporary softening of fine lines and has a smoothing effect on fine wrinkles.
Receiving injections every several months may not seem non-invasive, but other techniques definitely go a step further. One such option is injection of fillers. These fillers range from gels that are available off the shelf (such as hyaluronic acid) to your own fat, which can be harvested and injected to fill wrinkles in the face. Fillers such as hyaluronic acid are temporary and can fill deeper wrinkles that Botox may not work well on. However, these fillers are foreign materials and can sometimes lead to adverse reactions. They can be injected in the physician's office with minimal or no anesthesia.
Fat injection is slightly different. On the one hand, fat is the ideal filler (because it is from your own body and may be a permanent filler), but it also has a significant drawback. To obtain the fat to inject, your plastic surgeon will have to give you sedation or anesthesia and harvest the fat from another part of your body. The stomach and thighs are frequent donor sites. Regardless of the material, fillers can soften the effects of wrinkles but cannot correct looseness of the cheeks, eyelids or neck.
Surgery is often needed to address areas of loose skin in the face and neck. Removal of extra skin and tightening of the muscles and tissues below is often referred to as a facelift (rhytidectomy) or necklift (cervicoplasty or platysmaplasty). A necklift can correct the turkey-gobbler appearance that people often complain about. Redraping of the skin of the neck as well as disruption of vertically-oriented muscle bands can give a more youthful appearance. A necklift takes anywhere from one to two hours and needs to be done in an operating room with some form of anesthesia.
The facelift procedure is similar: Facial skin is lifted up. The deeper tissues are tightened with sutures, and the skin is redraped after any excess is removed. Scars are usually hard to detect after healing since they're hidden near the hairline and along the ears. Facelifts require an operating room and anesthesia of some sort, and operative time can vary from more than one hour to several hours. The effect is usually dramatic, though the best surgeons will get a rejuvenated but natural result. Results will vary but should last a number of years, unlike Botox or fillers.
Other procedures can be combined with facelifts to raise the eyebrows to a more youthful level (they can droop with age), to rejuvenate wrinkly eyelids, to reduce jowls or to fill and plump the lips. Facelifts are still very popular but cost more than many other procedures and are more invasive.
Other than a facelift, the procedure that people most commonly associate with cosmetic surgery is breast augmentation, or breast implants. Breast augmentation is a close cousin to another procedure plastic surgeons do commonly: breast reconstruction after cancer. As with other cosmetic surgeries, breast augmentations leave scars. Plastic surgeons try to hide these scars in the armpits, along the margin of the nipple or in the skin crease where the breast meets the abdomen. However, what most patients are more interested in are the type and size of implant.
Two main types of breast implants are available. These are saline (saltwater) filled implants and silicone implants. The big difference between the two types is their consistency or feel. Silicone more closely matches the feel of breast tissue and may appear more natural as well. Also, to aid in the natural appearance, most implants are now placed under the chest muscles, against the ribs. Even here, they can make mammogram exams difficult. For that reason, breast surgeons often suggest regular MRI exams to rule out breast malignancies.
Also, no implant will last forever. There is a small but definite risk of rupture, which increases with time. Despite these concerns, breast implants remain very popular, not only in Hollywood, but also in society in general. Breast implants take an hour or two to insert and may require other tailoring of the breast to ensure symmetry. This is done in an operating room with anesthesia.
In the last decade, certain cosmetic procedures such as tummy tucks, or abdominoplasty, have become vastly more popular. A major reason is society's acceptance of the tummy tuck, especially in women who have finished having children.
Tummy tucks can make a huge difference in a person's appearance and self-image. You can imagine the effect of being able to see one's belt again after many years, as well as being able to fit in new, slimmer clothes. As part of the procedure, most of the redundant fat around the waist is removed. The abdominal "six-pack" muscles (the rectus abdominis muscles), which may have been long-hidden by excess fatty tissue, are tightened as well. In some cases, a modest amount of liposuctioning to the sides of the hips (aka the flanks) is performed as well. This helps to smooth the curves of the tissues in the area, and can add to the slimming effect of the tummy tuck.
But with all of these benefits, there are risks as well. Tummy tucks are associated with the highest number of complications of any cosmetic surgical procedure. These can include blood clots in the legs, though this is rare. Also, females who decide to have a child after the surgery can stretch out the muscle repair and render it ineffective. The procedure takes two to three hours and does require anesthesia and a visit to the operating room.
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