When Plastic Surgeons Say No

By Sultan, Mark R. | USA TODAY, May 2005 | Go to article overview

When Plastic Surgeons Say No


Sultan, Mark R., USA TODAY


"Cosmetic surgery can be a powerful tool, but it cannot change who you are. It can supplement, not substitute."

IN THE LAST DECADE, the number of patients undergoing cosmetic plastic surgery has increased a staggering 393%, reports the American Society of Plastic Surgeons. In a recent 12-month period, 6,600,000 people underwent cosmetic procedures. More than one-third of those individuals already had at least one prior procedure.

To a great extent, this phenomenal growth reflects the uniquely American commitment to self-improvement and the desire to maintain a youthful, healthy look. Once "almost exclusively the domain of senior citizens, plastic surgery increasingly has become common among baby boomers and Generation Xers. According to the American Society of Aesthetic Plastic Surgery, persons aged 35-50 accounted for the most cosmetic procedures in 2002: 44% of the total. People aged 19-34 were responsible for 25%, and those between 51-64, 23%.

However, just because plastic surgery has become so well-established does not mean that it is appropriate for everyone. Precisely because of the popularity of plastic surgery, a new breed of patient is emerging: those in pursuit of perfection, who believe that anything can be achieved with such procedures. It is not that simple. Although some patients may not know when to say "no," most plastic surgeons do.

The media--including television shows such as FX's edgy "Nip/Tuck" and ABC's "Extreme Makeover"--are fueling popular misconceptions about cosmetic procedures. Viewers are encouraged to regard extreme changes as the goat when, in fact, the primary benefit is an improved self-image and enhanced self-confidence.

All conscientious surgeons know that one of the keys to a successful outcome is establishing realistic, clear communication between patient and physician. Patients must voice their goals and concerns, while surgeons must provide a complete understanding about any proposed procedure, including its benefits as well as its limitations and risks. Satisfaction most often occurs when patient and physician agree on what realistically can be accomplished. Patients routinely are told to expect improvement, not perfection.

Therefore, when considering plastic surgery, one must be aware that there are a number of reasons why it may not be the correct option. In my practice, for instance, I routinely say no to approximately 20% of prospective patients--for a wide range of reasons:

* The change would be so subtle that it is not worth making. When there is very little to improve, the benefits of the surgery will not outweigh the risks. In one recent case, a twenty-something woman who was troubled by what she described as "sagging" around her eyes was intent on a brow lift. It was clear, however, that she did not need cosmetic surgery--of any kind--at this stage in her life. Instead, I suggested she consider enhancing her makeup or reshaping her eyebrows to open up the eye area. Before considering any surgery, cosmetic or not, first determine whether simpler, conservative approaches might accomplish similar goals.

For example, makeup can help conceal early wrinkles and dark under-eye circles. A sensible, balanced diet and a regular exercise regimen--including cardiovascular and muscle-strengthening resistance training--are simple, cost-efficient beauty enhancers available to virtually everyone. (If you are considering a program of vigorous exercise, talk to your physician first, especially if you are sedentary and over the age of 40.) In fact, improving one's shape by more natural methods can be significantly more efficient and effective than surgery.

* The requested surgical procedure is not possible. Sometimes, patients present completely unrealistic requests. Perfect examples are the obese woman who believes that liposuction alone will give her a petite figure or the young man with exceptionally thick skin who requests a very refined nose. …

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