Cosmetic surgery may provide the opportunity for you to feel better about how you look. According to statistics from the American Society of Plastic and Reconstructive Surgeons, 1,045,815 cosmetic procedures were performed in the United States in 1998, demonstrating a 153 percent increase since 1992. Liposuction is the most commonly performed cosmetic procedure in the United States. Breast augmentation is second, followed by eyelid surgery, facelifts and chemical peels. More Americans pursue cosmetic surgery for several reasons. Cosmetic surgery may improve self-image and confidence levels. Some patients feel a more youthful or athletic appearance gives them a competitive edge professionally. Some have just been unhappy with a particular body part and want to make a change. All of these are valid reasons to pursue cosmetic surgery. A good candidate for cosmetic surgery is someone who understands the procedure, is realistic about expectations of the surgery and is motivated primarily to please him or herself. It is not a good option for people in a life crisis, such as a divorce, who think the surgery will solve their problems. Because of the increased demand for cosmetic, media of all types have developed a great interest in the subject, particularly in complications associated with elective cosmetic procedures, such as liposuction. These cases underline the point that even if surgery is not life-saving, it can be life-threatening. It is important to find a board-certified or board-eligible plastic surgeon who is well-trained in cosmetic surgery. It is also important to have surgery performed in an accredited hospital setting where anesthesia and other support services are readily available, if needed.
FaceliftFacelifts are performed to tighten the skin of the face and the neck and give the patient a more youthful and rested appearance. This may be performed in conjunction with eyelid surgery, brow lifts and peels. Both men and women are candidates. This procedure is usually performed under general anesthesia. The surgery lasts between three and six hours, depending on the amount of surgery necessary and desired. Although many patients leave after surgery, an overnight stay may be useful for observation and assistance. The majority of the swelling usually subsides after two weeks, but it may be several months before all the swelling has disappeared. Scars typically fade over several weeks to months and, in most cases, are not very noticeable. Numbness in areas near the incisions is normal for several months following the surgery, and in almost all cases disappears with time. Patients who smoke are at increased risk of wound healing problems at the incisions. Cessation of smoking is ideal prior to pursuing facelift surgery; cutting down the amount of cigarettes smoked has also been shown to be beneficial. It is difficult to say how long the results of facelift surgery will last. Over time, the skin relaxes again. More in-depth information can be gained through consultation with a plastic surgeon.
Blepharoplasty/Browlift Excess skin, wrinkles and fat can make the eye appear tired and old. Blepharoplasty and browlifting procedures may help make the eye appear rested, crisper and more youthful. The brow plays a large role in aging around the eyes. As the brow descends with gravity and age, the eyes appear older and more fatigued. Browlifting opens and refines the area around the eyes. Two major methods are available for browlifting: endoscopic, minimally invasive technique and the open technique. Endoscopic browlifts are performed through small incisions behind the hairline through which a camera and dissecting instruments are placed. The results appear natural, and there is minimal scarring. If there is wrinkling of the forehead, an open technique will give better results. In this situation, an incision is made either at or behind the hairline to allow the surgeon to pull up the forehead and brows. This surgery allows better lift and wrinkle treatment in exchange for a larger scar. Treatment needs to be individualized to each patient. Blepharoplasty treats the excess skin and fat directly around the eye. For the upper lid and incision is made within the crease of the eye to remove excess skin and fat. The lower lid may be approached two ways. One way is to make an incision hidden in the conjunctiva of the eye to remove fat. The other incision is below the lashline, and allows removal of both fat and skin. The surgery, which is outpatient, takes approximately two hours to perform, and requires either local or general anesthesia. Incisions heal within one week, but it may take several weeks to months for swelling and scarring to subside. Patients with dry eyes or lax eyelids require special care that they should discuss with the plastic surgeon.
Skin resurfacing Skin resurfacing helps rejuvenate the skin, to treat wrinkles, texture and pigment in the skin resulting from acne, age and sun damage. The two best therapies available now include chemical peels and laser resurfacing. The depth of skin treatment differentiates chemical peels. Glycolic acid peels treat superficial levels of the skin while phenol peels penetrate more deeply. TCA peels fall in the middle of this spectrum. They work to peel off the upper layers of the skin as a deep sunburn would. More youthful skin is revealed after healing is complete. It takes two to three days to start peeling, and the process lasts about five days beyond that. The face must be kept clean and moist while the skin heals. The patient also must stay out of the sun due to sensitivity. The peel is performed in the office with Valium sedation. The best results occur with six-eight weeks of pre-peel skin care prescribed by the plastic surgeon. Many patients like the peel for the results they see and the short investment in healing time. Laser resurfacing more aggressively treats the skin for rejuvenation. It can treat deeper wrinkles and surface irregularities from acne scarring. Skin specimens analyzed after laser therapy demonstrate reversal of changes related to sun damage and more organized collagen. Because laser is more aggressive, peeling is prolonged to approximately seven-ten days post-laser. Skin care is intensive, with frequent cleansing and lubrication. Sun avoidance is critical. The main problem after laser is pink coloration of the skin, which may last up to three to four months. But for the greater price paid, the benefits gained are great. The results from laser resurfacing last for years, and give the smoothing effect of a facelift for patients who do not have much excess skin.
Surgery of the nose (rhinoplasty) Cosmetic nasal surgery helps bring the nose into harmony with the face and improve overall appearance. There is no standard procedure for rhinoplasty. Each patient needs individual evaluation for characteristics they desire to change. The principle of the procedure is for the surgeon to separate the skin of the nose from the underlying bone and cartilage framework, reshape them, and then allow the skin to reshape over the enhanced framework. Commonly performed procedures include the removal of a hump, narrowing the nose, and refining the nasal tip. Many patients have deviation of the septum causing breathing difficulties. This treated at the same time. Some patients may require chin surgery to better balance the face.
The surgery takes one to three hours and is performed under general anesthesia. Patients usually go home after surgery. Dressings may include internal and external splints as well as packing. Bruising and swelling begin to resolve at two to three weeks, but take months to completely disappear.
Ear surgery (otoplasty) Otoplasty surgically reshapes the ear, particularly in cases where the ear is too prominent. Surgery is performed with either local or general anesthesia, and is outpatient. The incision is made behind the ear. Revisions include better defining a fold of the ear and flattening ears that protrude.
Lip augmentation Recently lip augmentation has become quite popular. Techniques include adding material to the lips or advancing lip tissue to enhance lip fullness. Preferred materials that can be added to the lip include fat grafts, fascia grafts, scar tissue and processed dermal substitutes. The lip is numbed and small incisions are made in the corners of the upper and lower lips. A tunnel is created and material is placed in the tunnel to augment the lip. Fat grafts may be directly injected into the lip. This fat is taken from another area of the body. Lip advancement techniques create cuts in the mucosa of the lip, allowing the lip to advance forward, making it fuller. Results with this technique are longer lasting than with the others, which might only last up to a year. Lip augmentation may be performed under local anesthesia in an office or minor surgery setting with sedation. Swelling resolves in one to two weeks.
Breast enlargement and lifting Breast augmentation is the second most common plastic surgery procedure performed in the United States. Since the silicone implant controversy in the early 1990s, only saline implants are available for first-time augmentation patients. Of note, after an intensive two-year review process, scientists from the independent National Science Panel found no evidence linking silicone breast implants to systemic disease. Because the body recognizes saline, it tolerates it well. The downside of this is that saline from the implant is slowly reabsorbed back, resulting in slow volume loss and eventual rippling. Like any man-made product, implants have a limited lifespan and will probably need to be replaced within the patient's lifetime. Implants may be placed above or below the chest-wall muscle, and incisions may be made in the breast fold, around the nipple, or under the arm. Different shapes and sizes are available. All decisions are made by the patient and surgeon to find the best fit for the patient's build and lifestyle. Breast lifting (mastopexy) in patients who have sagging breasts or breasts that have lost volume over the years may be performed in conjunction with breast augmentation. In some cases, the augmentation on its own may provide enough lift. In other cases more needs to be done. Some techniques only require an incision around the nipple-areolar complex, while techniques for greater lift require a T-incision on the breast similar to breast-reduction incisions. The best option for each particular patient is chosen according to breast shape. Breast augmentation and breast lifting are outpatient procedures that take between one and three hours. One week of rest is needed, and activity levels are slowly increased over the next several weeks. A support bra is initially necessary after surgery.
Body contouring Body contouring surgery includes liposuction and excisional body lifts. Liposuction is the most popular cosmetic procedure performed in the United States, with patient numbers increasing 264 percent since 1992. A good liposuction candidate is stable in weight and has localized fatty deposits that will not disappear with diet and exercise. Liposuction may be performed under local or general anesthesia. First, a solution containing lidocaine, for comfort, and epinephrine, to decrease blood loss, is injected into the area to be liposuctioned. There are two major ways fat can then be removed. In the traditional method, small tubes attached to a vacuum source are placed under the skin to remove the fat. The newer method is ultrasound-assisted liposuction (UAL). With this method, ultrasonic energy is administered to the fat, forming an emulsion. This liquefied fat is then removed. UAL is appropriate for fibrous areas, large areas, and redo liposuctions. Postoperatively it is necessary to wear a compression garment for six to eight weeks. Recuperation is usually less than a week, but varies depending on the individual and the amount suctioned. The main risks of surgery include asymmetry, under-resection and over-resection. Touch-ups can be performed under local anesthesia. Excisional body lifts include tummy tucks, buttock lifts, inner thigh lifts, circumferential body lifts, and brachioplasty (arm surgery). Excisional lifts are necessary when there is excess skin or areas where liposuction results would be insufficient. The scars are greater than in liposuction, but the contouring result makes the scars worthwhile. Often, drains are necessary and patients learn how to empty and record them. At least an overnight stay is typically necessary. Initial discomfort may last up to four weeks, but a period of months is necessary to see the final result. In-depth analysis of body habitus and lifestyle are important for the surgeon to decide which technique is best for patients. | 
