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Cosmetic Surgery
When and why is it necessary?

Is plastic surgery vanity, pride or something in between? No one would question the benefit of otoplasty (ear pinning) in an elementary school child who desires this change in appearance. We all realize what a big difference it can make to a child who has been teased with names like "dumbo." But why are we so quick to criticize others who submit to surgery to improve their appearance?

I believe in cosmetic surgery because I see the happiness that can come from my work as a plastic surgeon. But did I always feel this way? Initially I was attracted to the specialty because of the combination of art and science. Hand surgery was fascinating and intricate. Each reconstructive procedure was a case of design and execution.

As time passed, I began to think of cosmetic surgery in my own life. I realized that growing old gracefully was not going to be so easy. People often commented that I looked tired or angry. After I had the excess skin taken out of my upper eyelids (blepharoplasty), no one noticed that I had the surgery. They just stopped noticing that I looked tired. Similarly, Botox™(botulinum toxin) dealt with the angry appearance that would come across my face when I concentrated.

When I was in New York finishing my residency, I brought my younger sister to the city so one of my colleagues could perform her nose surgery (rhinoplasty). My father and brother were not pleased - how could I take a happy-go-lucky 20-year-old and subject her to surgery? After her problem was gone, my sister realized how self-conscious she had become about her appearance and how much better she felt about herself. My family became converts when they saw how she blossomed. It was interesting to hear relatives say to her, "Your nose looks great - you didn't need to have surgery." Then they would look at old photos and say, "I don't remember you looking like that!"

But that is exactly what cosmetic surgery does. It makes certain features (like droopy eyelids, prominent ears and obvious noses) look less noticeable.

Why is it called 'plastic' surgery? The word plastic comes from the Greek word 'plastikos' which means 'to mould.' The polymer industry used the same root to describe the plastics that are moulded into so many shapes we live with every day. It is just coincidence that plastic surgeons sometimes use plastic materials.

Plastic surgery is divided into 'reconstructive' and 'cosmetic.' Reconstructive surgery takes the abnormal and tries to make it normal. Cosmetic surgery takes the normal and tries to improve upon it. It takes a basic knowledge of surgical principles combined with an artistic eye and skill in design and implementation.

In these days of buyer beware, it is essential that patients do their own research. Three-day courses do not qualify a doctor as a plastic surgeon. In Canada, look for the FRCSC (Fellow of the Royal College of Surgeons of Canada) after the name. Nothing is without risk, but surgery is far safer than many of the other things we do to make us feel good! To be sure that you find a good plastic surgeon, ask your family doctor for a reference or call the Canadian Society of Plastic Surgeons (800-665-5415) for the name of a reputable plastic surgeon in your area. They also have a web site at www.plasticsurgery.com. Bad things can happen, especially in the hands of untrained operators.

Liposuction is probably the most misunderstood plastic surgical procedure. The procedure contours the body shape, but does not remove any skin. There is some slim shrinkage that occurs with the new techniques. On the other hand, if the patient has significant excess skin around the abdomen, a 'tummy tuck' or abdominoplasty is needed.

People often ask, "Isn't liposuction dangerous?" Many of my most satisfied patients are athletes who just wanted that extra bulge on the thighs removed. It is less a matter of diet and exercise than it is the genes we inherit from our parents. Of course, liposuction should not be performed for weight loss - it is a contouring and shaping procedure. Think of it as those piles of snow on the side of the road - the highest piles are the last to melt.

Breast augmentation, breast reduction and breast reconstruction all have differing indications. Breast reduction surgery is one of the most satisfying to patients, in spite of the often extensive scarring. Breast augmentation surgery is performed less often for Baywatch reasons than for patients who lost breast tissue in pregnancy or who never developed much to begin with. After extensive studies, it is clear there is no relationship between silicone breast implants and auto-immune diseases. Breast reconstruction after cancer and breast reduction surgery are usually covered by provincial health care plans.

Ear pinning (otoplasty) is one of the most satisfying procedures for a plastic surgeon. Children can have the surgery beginning around five years old. The difference in appearance and behaviour in these children can be phenomenal. Surgery can be performed over a school holiday and by the time school is back, the other children totally forget that the child's ears used to stick out. Most provinces will cover the cost of this surgery - and so they should.

Rhinoplasty surgery changes the shape of the nose and is often combined with septal surgery to help improve breathing. Check with your surgeon, because part of the procedure may be covered by insurance.

Blepharoplasty is surgery on the upper and/ or lower eyelids to remove excess skin and fat. It is a fairly simple procedure for the patient that can be performed under a local anaesthetic and can make a dramatic difference. Patients look brighter and more alert.

A brow lift is performed when the eyebrows are low and create a heavy appearance around the eyelids. This is often done with a scope so that the scalp incisions are minimal. Chin implants can complement both rhinoplasty and face lift surgery. Our society seems to interpret a receding chin as weak and a prominent chin as evidence of a strong character (just think of a few politicians over the years!).

Face lift surgery can be frightening -especially with so many poor results that show up in the media and in actors and actresses. It is definitely more involved than other facial procedures, but the results can be rewarding. Be sure to check whether your surgeon prefers a natural or a pulled look.

Skin texture cannot be improved to any major degree with face lift surgery. Certain skin care products, such as glycolic acid (removes outer skin layers), vitamin A acid (fills in fine lines) and hydroquinone (bleaches pigmented spots) can make some difference. For more improvement, patients can choose between chemical peeling and full face laser resurfacing. Patients need to expect that the more improvement they desire, the more recovery time is involved.

Collagen and Hylaform injections, Botox™ injections and fat injections are used to decrease some of the lines and hollows that develop with time and gravity. They are often combined with surgical procedures to maximize the desired result.

What is the right age for cosmetic surgery? There are no rules. So much depends on the nature of the problem, how much improvement is possible, and how much it bothers the patient. What is a concern for one person does not bother the next.

The only rule is that the person who benefits the most from cosmetic surgery is the person who psychologically needs it the least. Just as we do not like to let our houses grow old gracefully, a new kitchen is not going to save an unstable foundation. Similarly, cosmetic surgery is unlikely to save a failing marriage.

Patients must have realistic expectations. We cannot change a personality or give a person a new career. All we do is help boost self-confidence. We cannot give patients the self-esteem that may be lacking for other reasons. So remember, when someone discusses cosmetic surgery - be open. It may not be for you, but the results in your friend or family member can be dramatic. And our best results as surgeons often go completely unnoticed!