When I think of the strides in plastic surgery, I immediately drift back to my days eagerly awaiting episodes of The Six Million Dollar Man and The Bionic Woman, and I relate to their famous turn of phrase, “they can ‘rebuild’ us.” They can make us “better” (younger), “stronger” (at least in confidence), and “faster” because when you look good, you feel good. Coincidentally, it was Hollywood that made us aware of the real meaning behind, “having some work done.” Today, the cosmetic surgery phenomenon has moved way passed its Hollywood circles. In fact, the American Society of Plastic Surgeons (ASPS) reports cosmetic procedures are a $10.1 billion industry on the rise with a 5 percent increase in cosmetic plastic surgery and a 2 percent increase in reconstructive procedures. Men and women are making the choice for reasons ranging from competing in the work place to correcting a scar or defect to changing a feature, or simply to boost self-esteem. Whatever the reason, there were more than 13.1 million cosmetic procedures in 2010.

What are the choices?
Honestly, there are many choices and they are constantly evolving, so it’s an exercise in research, asking questions, and defining what’s right for you from both a medical and personal standpoint. The instruments being used today range from knives and needles to lasers to endoscopic (scope) to ultrasound waves to chemicals and even suction cups that reportedly freeze fat. There are variables involved, but basically, our options are open to two primary categories: cosmetic and reconstructive. Further, cosmetic or aesthetic plastic surgery can be broken down into surgical procedures such as breast augmentation, nose reshaping, eyelid surgery, liposuction, and tummy tucks; or minimally- and non-invasive options like Botox®, soft tissue fillers, chemical peels, laser hair removal, and microdermabrasion.  

What is the difference? Dangers?
Simply put, a surgical procedure, whether reconstructive or cosmetic, is real surgery with general anesthesia and involves cutting under the skin to make alterations working around veins, capillaries and bodily fluids. Minimally invasive alternatives are done with a viewing scope through tiny incisions or with needles, ultrasound waves, lasers, etc. Non-invasive treatments do not penetrate or break the skin at all.  Typically, minimally invasive and non-invasive methods are done as outpatient procedures and use local anesthesia, oral or intravenous sedatives for comfort. Lasting effects can differ, but all procedures involve potential complications so ask your doctor.

Selecting a plastic surgeon or cosmetic procedure specialist
First, develop a list of candidates. One thing to consider is that no plastic surgeon has specialty expertise in every procedure. For instance, if breast implants are what you want, look for a surgeon who is recognized and referred to in regards to breast augmentation and one with a solid background. If a website is available, look for before and after pictures. It’s also important to verify that the doctor is board certified and has privileges at a good hospital. Great sources are your personal physician, friends, hospital personnel, and the American Board of Medical Specialties (ABMS); www.abms.org.  The ABMS offers a database to verify a doctor’s certification status, and you can also call toll-free 1-866-ASK ABMS (275-2267).

What questions to ask
Most plastic surgeons offer a consultation prior to discuss the best path for each individual. In fact, in speaking with Carolina Forest surgical and non-surgical med-spa owner and practitioner, Dr. Jerry Guanciale, a board certified general cosmetic surgeon by the American Board of Cosmetic Surgeons, he recommended a few key things to consider prior to moving forward with body image enhancement. First, “Have you considered the complications associated with the procedure?” Second, “Are you confident in the surgeon’s abilities that you have entrusted to perform the procedure?” And third, “Are your expectations for the final outcome reasonable and achievable?” He also supports questions suggested by the ABMS:

Is the office clean? Friendly?
Do you have a rapport with the surgeon?
Does the surgeon do the surgery himself/herself?
Does the surgeon spend time with you or is he/she rushing from patient to patient?
What are the costs?
What is the surgical procedure called? How is it done?
How often has your surgeon performed the procedure? What is his/her success rate?
What should I expect in my recovery?
Does your surgeon expect that future surgeries/procedures are needed?

FACELIFTS and FACIAL REJUVENATION SURGERY

Lasers: A specific wavelength of light is used to heat up the surface of the skin, which causes a burn of the tissue to remove the surface layer. When the skin surface heals, the regenerated cells give you a smoother and tighter face. It does not take away excess skin or larger folds, and reportedly, it is not effective in the neck area. ($500-$3,500)

Endoscopy: A small, flexible viewing scope is placed in small incisions to aid in minimally invasive lifts of the forehead, mid-face, eyelids, eyebrows, etc. The treatment has been coined as the “mini face lift” and costs range depending on the number of areas treated. Most patients are satisfied with the results and report a quick recovery with very little pain. ($1,800-$10,000)

Ultrasound technology: Patients are giving glowing reviews of Ulthera®, a non-invasive tissue lifting face and neck treatment that uses sound waves for the look and feel of a lifted brow and tightened skin. According to the manufacturer, it takes one 30- to 60- minute procedure for initial effects, but full-scale lifting occurs over the next 2 to 3 months. Pain is reported from mild warming sensations to very uncomfortable. ($1,500-$4,000)

INJECTABLES & FILLERS

otherwise known as “liquid facelifts,” are used as “anti-aging” remedies and can restore fullness to your face, enhance lips, reduce the look of scars, and smooth wrinkles and lines. They’re available for a lower cost than surgery, but they are not permanent. Some are made of natural substances like fat from your own body and others are synthetic. A rundown follows:

ArteFill: A synthetic suspended in bovine collagen and used for smile lines, lip augmentation, acne scars and more. Effects can last for 5 years or more. ($500-$2,500)
Botox: Paralyzes muscle contractions and wrinkles disappear for about 3 months. ($300-$465 per treatment)
Dysport: A “botulinum toxin” similar to Botox® is for improving the appearance of moderate to severe frown lines, forehead and crows feet. ($250-$800 per treatment every 3-4 months)

Juvéderm: A gel implant containing hyaluronic acid, and used for facial wrinkles and folds. The body naturally absorbs it after about six to 9 months. ($430-$530 per treatment every 6-9 months)

Radiesse: A biocompatible treatment that lasts two years or more and used for filling wrinkles and folds around the nose and mouth.  ($800-$1,200)

Restylane: Clear liquid gel and a natural sugar compound that reduces facial wrinkles, particularly around the mouth and nose. Treatments can last six months or more.  ($430-$530 per treatment)

Sculptra Aesthetic: A synthetic, biocompatible substance that restores and corrects the signs of facial fat loss by replacing lost volume. Lasts 1 to 2 years. ($995-$1,650)

BREAST AUGMENTATION is a one- to two-hour surgery involving the placement of saline (salt water) or silicone implants in the breast either behind the breast, underneath either breast tissue or the chest wall muscle. Most feel the saline-filled breast implants are softer and more natural. Often, a breast lift is recommended in conjunction for more satisfying results. ($5,000-$15,000)

FAT HARVESTING/GRAFTING is a hot treatment. Dr. Guanciale, defined this as “a surgical procedure designed to harvest the patient’s own body fat and then administer the fat as filler to the patient’s desired targeted area. Most commonly, it is used in the face, lips and hands resulting in a more youthful look through reduced wrinkles and rejuvenation of sunken areas by enhancing soft-tissue volume.”

BUTT LIFTS for both men and women are trending high on the list of must-have surgeries, and whether it’s Brazilian or something along the lines of a Jennifer Lopez asset, curves are in. ($2,000-$10,000)

BODY CONTOURING
Liposuction remains the industry-standard, but there are new, experimental non-invasive techniques for fat removal such as freezing, zapping and lasering. Dr. Guanciale says laser lipolysis makes up about 95 percent of his liposuction procedures. “Assisted lipolysis allows the patient to achieve body contouring with fewer contour deformities, smaller incisions, less bruising and less blood loss. The laser uses optimal wavelengths to selectively melt and remove fat while at the same time, coagulating soft tissue and tightening the skin. Laser liposuction is a minimally invasive body sculpting solution that safely ‘melts’ fat away with less pain, less downtime, and consistent aesthetic outcomes resulting in fat reduction, smoother body contouring and superior skin tightening in the targeted treatment area.”