The appeal of cosmetic surgery probably increases with the number of candles blazing on your birthday cake. After blowing out the latest inferno—and viewing the celebratory pictures—many a celebrant will decide it’s time for some self-improvement. But where to start?
[combo surgeries]
Especially popular with young moms and the more matronly (or patronly) alike, combo surgeries are the proverbial two-fer. They may not exactly offer ‘two-for-one,’ but they do come with other attractive features. For one thing, you can tackle two related problem areas at the same time.
And there are indeed some cost- and time-cutting benefits. “Combining operations may allow for fewer down times and less time off work, so it is more cost-effective,” says Dr. Judith Gurley of Judith Gurley Plastic Surgery and Medical Spa.
“It saves recovery time and operating room and anesthesia costs,” adds Dr. Michele Koo. “Any combination of surgeries is possible. It depends upon what the patient requests and whether it makes sense and is safe. Often an insurance-covered procedure is combined with a cosmetic one.”
by the numbers
- 44% the percentag e of procedures in 2013 that were ‘combo surgeries’*
- 1.8M the number of America ns who had cosm etic surgery las t year**
- 91 % the percentag e of cosm etic surgeries in 2013 that were on women**
Most Popular Procedures & average costs**
Liposuction (up 16% from last year): $2,800
Breast augmentation: $3,500
Blepharoplasty: $2,700
Abdominoplasty: $5,300
*according to the American Society of Plastic Surgeons
**according to the American Society for Aesthetic Plastic Surgery (ASAPS)
mommy makeover
The procedures most requested by women are typically part of the combo known as ‘the mommy makeover’ (breast and tummy surgeries). “These have popularized the combining of procedures, but the concept has been around for a long time,” Gurley says. “Mommy makeovers restore two parts of the female figure at once to improve the damaging effects of pregnancy, nursing, C-sections, weight fluctuations and aging.”
The makeover also fits a combo criterion—location. “These two body parts are close enough together that it makes surgery and recovery easy. The breasts and belly can both be operated on in the same surgical field and can be clothed easily for post-surgical recovery and protection.”
have it your way
“There really isn’t a combination that cannot be done together,” says Koo. “The ‘makes sense’ part is the location of the surgery. Combination brow-lift, eye-lift and face-lift makes sense since I address the rejuvenation of the entire face. A complete face rejuvenation also can be performed with a breast lift or a breast augmentation.”
Combined facial procedures can bring enhanced outcomes, Gurley adds. “A combined approach can avoid the ‘operated on’ look. This involves maneuvers such as lasers for tightening, fat injections and fillers for plumping, and eyelid lifts for removing extra skin. These techniques can be done under anesthesia so there is no pain.”
Breast procedures are often scheduled with arm reductions or tummy tucks—the removal of excess fat and skin. “Breast reductions and tummy tucks are an excellent combination,” Koo says. “Breast reductions often are covered under insurance, along with an overnight hospital stay. The overnight stay can be used in conjunction with the tummy tuck, which is an elective procedure not covered by insurance.”
there are limits
Surgery combinations should not require more than six to eight hours in the operating room, Koo says. Ideally, they eliminate an additional anesthesia induction, even if the time under sedation is longer. “Whenever anesthesia time is lengthened there is increased risk,” Koo says. “But as long as I determine it is safe given the patient’s medical history, the additional risk may not be significant.”
While most beauty issues tend to be age-related, feet problems are the exception. It’s true that the older—and more traveled—your feet are, the more prone they’ll be to ‘issues.’ But even the young are at the mercy of foot pain and troubles.
no pain, no gain?
The pretty shoes that giveth also can taketh away. Stylish footwear can exacerbate foot issues. “Bunions and hammertoes can begin with genetic problems or trauma,” says Dr. Damon Hays of Hays Foot and Ankle Centers. “We sometimes see them in kids, but they really begin to manifest in the 40s and 50s.”
“These deformities may not be preventable, because you may be born with a genetic predisposition,” says Dr. Michael H. Horwitz of the Feet for Life Centers. “But you can prevent them from getting worse by keeping your feet strong and wearing shoes that are more minimalist, going barefoot more often, and not relying upon arch supports or supportive footwear.”
unsightly & unpleasant
“A bunion is a prominence or bump on the big toe joints that forces the big toe outward and is caused by a movement of a bone within the foot,” Hays says. “If you are born with a certain foot type, over time the joint unlocks and you develop a bunion. It can be exacerbated by shoe gear—high heels or anything pointy—or by trauma or chronic friction from running and athletics.”
Hammertoes are curled or buckled toes caused by imbalances between tendons on the top and bottom of the toes, Hays explains. “The lesser toes contract, and we often see bumps or prominences on the tops of the toes. They become very painful because of friction and are exacerbated by trauma or shoes.”
surgery or not?
Bunions and hammertoes are likely to be painful by the time their appearance becomes an issue, Horwitz says. “The American Board of Podiatric Surgeons approves surgical treatment for deformity, regardless of pain, but it is up to the surgeon to determine the most efficacious way to treat the patient,” he says. “We want to avoid surgery for the most part, and we want to use pain as the biggest indicator for doing surgery.”
toenail fungus
“There are skin diseases and fungal infections of the nails that can make the foot ugly,” Horwitz says. “Fungal nails are not easy to treat; at least half the time it is a year-to-year struggle to keep it under control.” The popularity of boots, particularly the trendy, thickly insulated type, “is creating record amounts of toenail fungus and athlete’s foot,” he confirms, because “people are sweating in those all day long.”
While the eyes may well be a window to the soul, they’re also a linchpin to looking young. And as luck would have it, they’re among the easiest things to fix on the face.
what goes wrong?
“The eyes are the context of the whole face,” says Dr. Bruce Kraemer, a plastic surgeon at SLUCare and Saint Louis University School of Medicine. Dr. Mike Nayak of Nayak Plastic Surgery agrees. “If people ask you why you are tired, angry or sad when you’re actually well-rested and feeling fine, that generally suggests your eyes and brows are conveying a false sense of tiredness, anger or sadness,” he says.
Unfortunately, one of the first features claimed by age and gravity is the forehead, the overlooked culprit behind many droopy upper eyelids. “As we age we get jowls and the eyebrows head south,” Kraemer says. “It usually starts at 35 to 40 years of age. As the eyebrows come down, extra skin collects on the eyelids.”
“There are patients who have a familial or genetic baggy eyelid look,” says Dr. John Holds of Ophthalmic Plastic and Cosmetic Surgery. “I have operated on women as young as their early 20s.” The lower eyelids also droop and puff with age as wrinkles gather at the corners of the eyes.
not just for women
Last year 216,000 people underwent eyelid surgery, the third most-requested plastic surgery in the country, the American Society of Plastic Surgeons reports. These operations, known as blepharoplasty, were the fifth most-requested cosmetic procedure for women (133,185), and the second most-requested by men (28,204). “We saw a wave 10 years ago when there was a lot of corporate downsizing. You didn’t want to be the sleepy-looking guy sitting around the table when your boss was going through reorganization,” Kraemer says.
Holds’ practice is visited by men ranging from high-level executives to union tradesmen, middle-aged to recently divorced. “I am surprised by the breadth of occupations and backgrounds,” he comments.
first things first
Non-surgical procedures may be sufficient. “Wrinkles due to muscle tone are best treated with Botox,” Holds says. “We also can get great results with laser skin resurfacing to tighten the skin.”
But when surgery is needed to correct droopy upper eyelids, the first step may begin above the hairline, where an incision is made while pulling up the forehead, Kraemer describes. “Sometimes when we put the brows back up where they should be, the eyes don’t have that droopy look.”
get the right results
Eye freshening procedures are typically performed on both eyes during one trip to the operating room. “It helps us keep them symmetrical,” Kraemer says. “A difference of only one millimeter from one side to the other can mean the difference between a good or bad result,” Nayak explains. “Eyelid procedures are among the least forgiving.”
The good news? These procedures earn high degrees of patient satisfaction, the doctors say. “Patients often report a 10- to 15-year improvement in their appearance,” Nayak confirms.