Thinking of tweaking the face or body this year? Fall and winter are the perfect times for cosmetic procedures—and the hibernation that often follows. If you plan it just right, you would have been indoors anyway, and nestled into layers of clothing. Think how much easier it would be to hide scars and bandages. Then in spring, like a chrysalis emerging, you’ll be ready for the sleeveless, carefree days of spring. A whopping 15.1 million cosmetic procedures were performed in 2013 (American Society of Plastic Surgeons), with rhinoplasty, blepharoplasty and breast surgeries leading the pack.
According to the American Society of Plas tic Surgeons, breast augmentation is the No. 1 most requested cosmetic surgery. In the United States, more than 290,000 women had breast augmentation in 2013. Maybe more surprising is who’s doing it: the number of women over the age of 50 and younger than 22 undergoing first-time augmentation is growing.
it’s not only about bigger
Breast reductions and lifts also remain popular choices, though Dr. Judith Gurley, director of Dr. Judith Gurley Plastic Surgery & Spa, estimates that for every one breast reduction she performs, she will perform two or three augmentations. Dr. Michele Koo, a plastic surgeon with Aesthetic & Hand Surgery, explains the popularity of both procedures as the desire to enhance the balance of the body and improve self-image.
“I completely disagree with the notion of ‘vanity,’” she says. “ If you have a dent in your car, would you fix it if you could? Of course you would, because you care about how you present yourself. How one looks often affects how confident and comfortable one is and how willing one is to work, interact and engage more fully in daily life.”
Gurley adds that breast surgery is often sought to correct abnormalities, asymmetries, imbalances and physical deformities that patients are self conscious about. “We shouldn’t judge whether someone is reducing their breasts because she is tired of men staring at her or because they are heavy and painful. Or enlarging breasts because her AA breasts prevent her from feeling confident,” Gurley says.
In some cases, breast reductions may be covered by insurance companies. The procedure is “medically advisable when one has rashes under the breasts and the breasts cause pain in the shoulders and back and prevent one from engaging in physical activities for a healthier lifestyle,” Koo points out. “A breast reduction can be a life-changing event that allows a woman to become more active and go on to exercise and become healthier.”
8 questions for anyone considering breast surgery:
1. How safe are these procedures?
Major advancements in surgical centers have maximized patient safety, comfort and recovery. “And new techniques are less invasive, allowing for quicker healing time and less scarring, all without compromising desired results,” Gurley says.
2. How long will implants last?
Breast implants should last approximately 10 to 20 years, Koo says. “The life of saline implants tends to be slightly shorter, and the presence of palpable ‘ripples’ also is more common with these after about five to 10 years compared with silicone.”
3. What is the right breast size?
Gurley recommends women choose a cup size that lies within the average range. “Outside of that norm, too small or too large, can be disfiguring and uncomfortable,” she says.
4. What is a breast lift?
Koo explains this procedure as the removal of excess skin and repositioning of the nipple areolar complex to the middle of the breast mound. A breast lift is always part of breast reduction, and may be needed with breast augmentation.
5. What should I expect during recovery?
Most patients experience minimal discomfort and only a few days of downtime. They typically can return to light exercise within two weeks, and will be fully recovered in 4 to 6 weeks. Both procedures are usually under $10,000, Gurley says.
6. How will I know if there is a problem with my implant?
There will be hardening (capsular contractures) and distortion in the shape and feel of the breasts if there is leaking or frank rupture of an implant, Koo explains.
7. Should implants be removed or replaced after 10 years?
If you are happy with your implants and there is no sign of a rupture, no. However, some women choose to remove or replace if the breasts have increased in size or started to descend. The surgeon typically also will remove any hard scar tissue that might be causing the breast to feel unnatural, Koo says, and may also perform a lift at the same time.
8. How should I choose a surgeon?
Do your homework. “Find a surgeon you trust, view lots of before and after photos of your surgeon’s previous work, and talk to former patients,” Koo recommends. “And make sure the surgeon shares your opinion of what your perfect breasts should look like.”
Droopy eyelids, puffiness and dark circles under the eyes are not only unattractive; they make us look older. And in this day and age, no one wants that. The ever-popular upper and/or lower eyelid surgery known as blepharoplasty might just be the single most effective way to shave a few years off your appearance.
what blepharoplasty can/cannot do
Dr. Steven Couch, a Washington University oculofacial plastic and reconstructive specialist, explains that upper eyelid blepharoplasty treats excess skin, fullness and heaviness in the upper eyelids. Additionally, surgeons can perform conservative skin and fat removal to get a safe and natural appearance. Lower eyelid blepharoplasty can address lower eyelid bags, puffiness and dark circles. Many patients choose to have both upper and lower procedures done simultaneously to achieve the best overall look.
But these might not address some of the attendant issues of aging. Dr. John Holds, a surgeon at Ophthalmic Plastic & Cosmetic Surgery Inc., notes that on its own, blepharoplasty typically cannot reverse the dynamic smile lines caused by loss of muscle tone or the secondary bags that extend into the cheek area. Laser skin resurfacing and chemical peels can treat eyelid wrinkles.
Couch says blepharoplasty patients should expect “a tailored surgical plan with any combination of cheek lifting, skin resurfacing with lasers or chemicals, dermal fillers, facial fat transfer and cosmeceuticals.” Some patients even can avoid lower eyelid surgery altogether with dermal fillers, adds Holds. And, the physicians note that eyelids will continue to age naturally, along with the patient, from the date of surgery.
costs
The total cost of eyelid surgery is dependent on the exact procedures being performed and the location of the procedure (office procedure room versus operating room), but can range from $2,500 to $8,000, Couch says. If severe drooping of the upper eyelid skin overhangs the pupil, as can be the case with older patients, that could constitute a ‘functional’ blepharoplasty, Holds explains. The removal of that skin to improve vision would likely be covered by insurance, although any attendant fat contouring or adjustments might not be.
why so popular?
“Upper and lower eyelid blepharoplasty remains the gold standard for cosmetic and functional periocular rejuvenation, thus they continue to be extremely popular surgeries,” says Couch. Its popularity is a no-brainer, in a costs/benefits assessment, adds Holds.
do your homework
As with any plastic surgery, the best outcomes start with choosing the right surgeon. Couch and Holds recommend looking for a surgeon who specializes in this procedure, has a number of treatment options to offer and has like-minded cosmetic goals. Ask to see before and after pictures from previous patients.
do you need a brow lift, too?
Changes in the collagen and elastin of our skin, along with loss and redistribution of facial fat, affect more than just your eyes, says Holds. Often when patients request an upper eyelid lift, it would be better instead to do a brow lift or a combination of the procedures. Doing them together allows surgeons to raise and smooth the forehead and brows, reduce overhanging skin, reduce upper and lower eyelid puffiness, and make everything look balanced and normal.
While the nose sticks out, it shouldn’t stand out. The face needs to be a harmonious blend of features, with no single aspect dominating. Thanks to social media and selfies, though, more people than ever are scrutinizing their noses—and they don’t always like what they see. This has caused an uptick in rhinoplasty, the already popular ‘nose job.’
who’s getting it?
According to WebMD, rhinoplasty is the most common cosmetic surgical procedure among teens. Dr. L. Mike Nayak, director of Nayak Plastic Surgery, says teens can consider elective rhinoplasty when they are physically and emotionally mature—generally around age 14 for girls and 16 for boys. Dr. William Hart, director of Hart Cosmetic & Reconstructive Surgery Institute, reports that about 75 percent of his rhinoplasty patients are women, and while most are young or middle aged, he also has done the procedure on patients in their 70s.
new & improved
Rhinoplasty can be used to remove a bump in the nose, straighten the bridge, reshape the tip or open breathing passages. These days, surgeons remove less cartilage and bone and even use small cartilage grafts and sutures to support the tip and middle, according to Hart. That explains why rhinoplasties from 30 years ago (when they did not take these measures) don’t look as good today.
Patient preferences also have evolved. “I believe a natural, softer look is more desirable now than it was in the past,” Hart says. “The scooped-out ‘Debbie Reynolds’ look is not as popular as it once was. Patients are more attuned in most cases to a contour that fits their face and, perhaps, in some cases, retains more of their ethnic character.”
ever-evolving
According to Nayak, patients are generally happy with rhinoplasty, but the result can change—for better or worse —over time. “If the result changes over time and the patient becomes less pleased, revision may be considered. But sometimes, the opposite happens: As swelling settles, they like it more,” he says.
But this ‘touch-up rate’ is not significant, 5 to 8 percent, according to Hart. “And most of them can be done under a local anesthetic in the office. Most rhinoplasty surgeons do not charge for these, either.”
Nayak points out, though, that rhinoplasty is an unforgiving operation: A good result can last forever, and so can a bad one. “It is worth seeking out a true expert in the field,” he says, “and paying a little more for expertise, judgment and experience. Your first shot is your best.”
Pricing varies, but generally ranges between $3,000 and $6,500, Hart says. And many surgeons now can offer 2D or 3D simulations of what the new nose will look like, though both doctors caution that these are estimates, not guarantees. Always ask to see before and after pictures of previous patients.
short & sweet
Injectables are now being used as an alternative to surgery, reports Nayak. These can’t remove tissue from the nose, but in the right hands, they can alter the proportion and disharmony of the nose and create the illusion of a smaller one. And they can revise a previous rhinoplasty.
Injectables are considerably less expensive ($600 to $1,800), and the results last for years, Nayak says. And unlike rhinoplasty, injectables can be reversed if the patient is unhappy. “As with all rhinoplasty, the quality of the result lies in the skill of the person performing it. Judgment and artistry are key,” he says.