Thursday, January 6, 2005

Cosmetic Surgery is Increasing in Popularity

Is Everyone Doing It?
Cosmetic Surgery is Increasing in Popularity — for Some Very Good Reasons. Not so long ago, cosmetic plastic surgery was one of those "does she or doesn’t she?" topics. Except for obvious celebrity transformations such as Ivana Trump and Cher, many people couldn’t be sure why even a good friend looked so rested and relaxed after a recent trip to Manhattan or southern California. On the newsstand, articles about cosmetic plastic surgery were generally confined to magazines devoted to health. Today, however, cosmetic surgery has become a popular subject at suburban cocktail parties, coffee shops and in the workplace.

Articles about microdermabrasion ("Improve your complexion on your lunch hour!"), collagen injections ("Kiss your thin lips goodbye!") and other cosmetic surgery trends can be found every month in high profile fashion magazines such as Vogue, Harper’s Bazaar and Elle.

An Affordable Option for Millions of Americans
No longer the private domain of wealthy women, cosmetic surgery is rapidly becoming an affordable option for millions of Americans. Recently, a vibrant 73 year old woman approached a plastic surgeon at a Minneapolis cocktail party. Smiling, she said "I know who you are, I know what you do and I’ve been thinking about breast implants." As they chatted, she told him that she was a widow and that she felt it was time to do something that made her feel good about herself. She said "I could go out and buy a whole new wardrobe, but I want to do something more meaningful for myself. I realize there will be some risk, some pain and some recovery time associated with the surgery, but to me, it’s worth it." As the surgeon recounted their conversation, he smiled and said "This woman’s vitality, confidence and realistic expectations make her an ideal candidate for cosmetic surgery. I’d be honored and delighted if she chooses me to be her surgeon."

Over One million Procedures in 1998
According to statistics published by the American Society of Plastic and Reconstructive Surgeons (ASPRS), the number of cosmetic surgery procedures has increased 50 percent over the last two years and 153% over the last six years, to top the million mark at 1,045,815 in 1998. Liposuction, at 172,079 procedures, (a 57% increase since 1996 and a 264% increase since 1992) remains the most commonly performed cosmetic procedure in the United States, followed by breast augmentation at 132,378 procedures (a 51% increase since 1996 and a 306% increase since 1992), eyelid surgery (120,001 procedures), facelifts (70,947 procedures) and chemical peels (66,002 procedures).

Cosmetic Surgery for Aging Baby Boomers
The ASPS has identified a number of trends that account for these dramatic increases in the number of cosmetic surgery procedures, including the vast number of aging baby boomers, the increasingly competitive workplace and the general decrease in the cost of cosmetic surgery. According to American Demographics, over the next ten years, a baby boomer will turn 50 every 8 seconds. Since 1996, when the first boomer turned 50, the number of cosmetic surgery procedures in this age group rose from 164,662 (1996) to 242,427 (1998), an increase of 47%. Says Paul Schnur, MD, ASPRS president, "Due to healthier lifestyles, men and women age 50 and older are feeling good about themselves and want to maintain a youthful appearance. As this large segment of the U.S. population ages, we anticipate the increase in cosmetic surgery to continue."

Competitive Workplace Pressures
Increased pressures in the workplace are one reason that 9 percent of all cosmetic procedures are performed on men. In bold letters, the cover of Fortune magazine (February 1) declares that experienced executives are "Finished at 40." Inside, the article states that "…a new trend is emerging: In corporate America, 40 is starting to look old." To combat the painful reality of this trend, more and more men are choosing liposuction to eliminate their not so lovable love handles, blepharoplasty to adjust their drooping eyelids and facelifts to boost their sagging jowls. Wrinkles, crows feet and other tell-tale signs of aging are being erased with laser skin resurfacing and chemical peels. Says Dr. Schnur, "More and more men are having cosmetic surgery, not only to look and feel younger, but also to give themselves a competitive edge in the workplace."

"I don’t Want to Look Like my Mother!"
Another reason why cosmetic surgery appeals to the baby boom generation is the ability to minimize their resemblance to their parents. As the first generation to dramatically redefine adulthood in America, both men and women boomers are loathe to let Nature take its toll. Says John M., a successful 49 year old business owner, "I run and do push-ups every morning, even when I’m on the road. I watch what I eat and I just got some hip new eyeglasses. Despite my best efforts, whenever I look in the mirror, I see my dad staring back at me!"

Says Claire N., a striking woman in her early 40’s, "I’m comfortable with my age – I didn’t mind turning 40 at all. However, when someone tells me that I look like my mother, I feel like crying!" When asked if she’d consider cosmetic surgery, Claire admits that she’s already scheduled a cosmetic surgery consultation as a birthday gift to herself.

Active, youthful boomers are not the only ones choosing cosmetic surgery. More seniors age 65 and over are choosing to enhance their retirement years with cosmetic surgery. Like the boomers, the most popular procedures with seniors are eyelid surgery, facelifts, liposuction and laser resurfacing. While many Americans may question the decision to undergo surgery at an advanced age, thousands of others would no doubt agree with the vibrant 73 year old Minneapolis woman when she says "I just want to feel good about myself again."

The Silicone Breast Implant Controversy

In 1992, the Food and Drug Administration officially banned the use of silicone breast implants in most cosmetic surgeries, citing concerns over the dangers of silicone leakage in the body.

Today reputable surgeons use saline-filled implants which are less harmful when leakage occurs but may still elicit an immune response if the silicone shell the saline is housed in breaks down in the body. I've performed numerous breast surgeries in the past 12 years and I myself have had silicone gel breast implants since 1985, -- so I can understand women's concern on this issue. Ongoing studies may not produce conclusive results for many years, but here is what we know so far:

1. All Implants Can Rupture or Leak.
Most silicone gel implants, especially those manufactured prior to 1985, were known to have small amounts of silicone gel "bleed" or leak through the shell. In the early 1980's, Dow Corning developed a "low bleed" gel implant with a silicone shell that was less likely to bleed, although this leakage occurs to some extent in all silicone gel implants-even those that have not ruptured.

Since silicone-gel implants were banned for use in most surgeries in 1992, plastic surgeons today generally use either smooth-wall saline-filled implants (which are felt to have fewer problems with wrinkling) or textured saline-filled implants (which have a lower incidence of capsular contracture, a tightening or hardening of the scar tissue around the implant).

2. Silicone Leakage in the Body Can Require Additional Surgery.
When saline-filled implants leak out of the silicone shell, the salt water is usually reabsorbed by surrounding tissue without much difficulty. But when silicone bleeds through the shell, it usually requires surgical removal of the material. Fortunately, the body tends to isolate the majority of the silicone within the scar capsule, making this removal much easier. It is important that the explanting surgeon use a technique that minimizes the risk of free silicone coming into contact with bodily tissues and that all of the scar capsule be removed, since it contains silicone particles.

3. Silicone Leakage May Cause Complications or Disease Elsewhere in the Body.
In the past three years, I've seen more than 120 patients with silicone breast implants who have suffered a variety of chronic ailments. Their symptoms range in severity from mild chronic fatigue and occasional joint and muscles aches to more debilitating illnesses, such as fibromyalgia, Lupus, and rheumatoid arthritis. Some plastic surgeons speculate that a low-grade chronic infection around a silicone gel implant may lead to a chronic illness, in which the immune system is unable to eradicate the infection or dispose of the foreign body.

The good news is that we have seen an improvement of symptoms after surgeons remove the scar capsule and implants. Patients often report return of their normal energy levels, sometimes within several weeks following surgery. Some patients only experience a partial improvement, but to date most have not had their symptoms progress unless large amounts of silicone gel still remain in the body.

4. If You Experience Symptoms of Rupture, Consult Your Surgeon as soon as Possible.
Any woman with silicone gel breast implants who experiences a sudden change in shape and/or contour of her breast, or develops burning pain or numbness and tingling in the arm should be evaluated by a plastic surgeon for the possibility of implant rupture. If you experience generalized symptoms such as chronic fatigue and muscle and joint aches-and especially if these symptoms are progressive-you may wish to consider removal of the scar capsule and implant, even if tests do not show a ruptured implant. If the symptoms are severe, I would not advise replacement of the implants with saline implants-recovery is often delayed if the saline implants are replaced at the time of implant removal.