Who is a good candidate for plastic surgery?

People who have health conditions such as diabetes, hypertension, lung disease, heart disease, high cholesterol, arthritis, emphysema, are malnourished, severely depressed, obese and/or smokers are not generally good candidates for cosmetic surgery. All surgery has inherent risks, but if you have a health problem it makes it more likely there may be complications. If you are overweight your heart has extra stresses and surgery may not be advisable. If you smoke or drink heavily, you may not be a good candidate. Any and all health conditions should be discussed openly with your cosmetic surgeon so they can help you make the most informed decision.

Smokers who do choose to have surgery must quit for at least 2 weeks prior to surgery and remain smoke-free until at least 2 weeks after surgery, for proper healing and recovery. Smokers have a higher rate of infection, skin separation, skin death, and anesthesia complications. One major study found that the risk of losing a significant area of skin (also called necrosis, or skin death) due to poor oxygen supply with a facelift is increased by 1500% in active smokers.

Ask the Doctor-

What are my choices in techniques and procedures?
What usually happens during the surgery? How long does the procedure last?
Where will the incisions be made?
How often do you perform these procedures?
What type of anesthesia is used? If general anesthesia is to be used, who will be my anesthesiologist? Are they certified by the American Board of Anesthesiology (ABA) or the American Association of Nurse Anesthetists (AANA)? What are the side effects of the sedation? (The three types of anesthesia used are general, sedation and local. With general anesthesia you are in a deep sleep, with sedation anesthesia you are awake but relaxed and drowsy, and with local anesthesia you are mentally alert but the area being worked on is numbed).
Where will the procedure take place? (If in the doctor's office, ask to see the surgical room)
If at the doctor's office, is the surgery center affiliated with a hospital or licensed by the state or accredited? (See Step 1 for verifying this information).
How much pain can I expect after surgery?
What are the risks involved with this procedure? What are the possible complications after surgery? How common are these complications? Have you ever had a patient with these complications? How was it handled?
Can I speak with your previous patients? (While doctors want to respect the privacy of their patients, they should be able to provide some contacts. You will only be referred to patients with a good result, but it can be helpful.)
Can I see before and after pictures of your other patients? (Request pictures of patients who have had the same procedure as you are planning. You may only be shown their best results. This is still informative, as you'll get an idea of what your doctor's best work is).
How long is the recovery period? How will it be before I will be able to: be seen in public, return to work, resume exercise, etc.?
How long does it take to see the full effect of my surgery?
How long will my results last?

A good candidate for Liposuction:
Is close to their ideal body weight (within 30%)
Wants to remove specific areas of fat that are diet- and exercise-resistant (fat pockets in the abdomen, arms, knees, inner thighs, love handles, neck, outer thighs
Weight has been stable for 6 months or more
Has good skin tone and elasticity
Does not have loose or saggy skin
Does not have stretch marks
Has realistic expectations
Is emotionally stable
Understands the risks of surgery
If you do not meet all of these criteria, but meet some of them, you may still be a good candidate for liposuction. The procedure is most suited to those who are close to their ideal body weight, but if you have a lot of fat in a isolated area, you may still be a good candidate. Some patients find liposuction to be a good incentive for weight loss, but it is not a remedy for obesity.

If you have good skin tone, it is more likely that your skin will respond well to the surgery. Patients with saggy skin or stretch marks are more likely not to tighten and may in some cases look worse. A thigh lift or tummy tuck (depending on your problem area) may be more effective.

Patients planning to have large volume liposuction, which involves the removal of more than 5 liters (5,000 cc's; about 11 pounds) of fat and fluid may have an overnight stay at the hospital.

You are also at increased risk for complications from liposuction if you have diabetes, poor circulation, heart, lung or liver disease, smoke, have a family history of blood clots, take certain medications, etc. You'll want to discuss your medical history thoroughly with your physician before you choose to undergo surgery.

liposuction procedures/techniques


Anesthesia: General, Sedation, or Local
Location: Hospital, surgical center or office
Surgery time: 30 minutes-4 hours
Quick Fact: Women have softer, less fibrous fat than men - making it easier to perform lipo

Which type of liposuction?
There are two basic techniques used in liposuction: tumescent and ultrasonic. Both techniques share core surgical elements. In fact, even if ultrasound is used, it will be followed by tumescent liposuction.

Tumescent liposuction is also called standard liposuction, liposuction, lipoplasty, liposculpture, liposculption, and suction-assisted lipoplasty. This type of liposuction has been performed in the United States since the 1982. First, the surgeon fills the fat with tumescent fluid (a solution containing saline and local anesthetic). Then, the fat is suctioned with long thin rods. The procedure can now be performed through a few small incisions, which can be hidden with natural skin creases. The tumescent technique may reduce blood loss and alleviate pain. The local anesthesia may be supplemented with intravenous sedation or general anesthesia.

Ultrasonic liposuction also starts with filling the fat with tumescent fluid to make the fat stiff. However, the fat is not suctioned, but liquefied with high-frequency ultrasonic energy with a long thin rod that emits ultrasonic waves. The rod is inserted into the fat through a tiny incision and then, the fat is suctioned out.

There are other sub-categories of the two techniques:

Suction-assisted Liposuction (SAL): The traditional method, by which the surgeon removes fat by inserting a small, hollow tube (cannula) connected to a vacuum pressure unit, directing the cannula into areas to be suctioned through tiny incisions.

Ultrasound-assisted Liposuction (UAL): Sound waves are transmitted to the tip of the cannula to liquefy fat before it is removed by suction.

External Ultrasound-assisted Liposuction (E-UAL): External ultrasound waves alter fat cells. The area is injected with fluid containing local anesthetic to transmit ultrasonic energy and liquefied fat is removed by suction.

Power-assisted Liposuction (PAL): A cannula with a back and forth motion of the tip passes through tissue to suction out fat and fibrous or scarred tissue with reduced effort.

VASER®-assisted Liposuction (VAL): Intermittent, or continuous bursts of ultrasonic energy can be used to break up fat cells which are then removed by suction.

liposuction recovery



Pain Level: Varies depending on procedure (ranges from mild to severe); 3-14 days of pain medication
Swelling: 2 weeks-2 months or more
Bruising: 2 days-2 weeks
Numbness: lasts several weeks
Bandages: Changed in 1-2 days (drains and sutures removed first 5-10 days)
Work: Return after 1-3 weeks
Exercise: Wait 2-4 weeks
Final result: Seen after 1-6 months

For faster recovery:
Drink adequate amounts of liquids to prevent dehydration
Avoid alcoholic beverages for 48 hours before and after surgery
Wear compression garments as suggested to prevent slow healing and excessive drainage
Do NOT apply ice-packs or a heating pad to skin overlying the liposuctioned areas
Do NOT apply hydrogen peroxide or plastic Band-Aids to incision sites
Do NOT soak in a bath, Jacuzzi, swimming pool, or the ocean for at least 7 days after surgery in order to minimize the risk of infection
Reduce your risk of fainting at home by: standing up slowly after urinating, remove compression garments slowly, have assistance for your first shower, sit down if you feel dizzy or lightheaded
Recovery from liposuction can be uncomfortable, but most people are back to work within 10 days. During the first few weeks most people experience varying degrees of pain, burning, swelling and temporary numbness. Pain medications can alleviate discomfort (usually taken for 2 days - 2 weeks) and a body-compression garment will minimize swelling. You will need to refrain from any exercise other than walking for about a week after the procedure. Slowly work your way back to your old exercise routine.

Consider a massage therapist for lymphatic drainage massage to relieve swelling and possible itching (discuss this with your doctor).

Although the new shape of your body usually begins to emerge in the first few weeks, some swelling may remain for several months. Major weight gain or loss after liposuction can produce skin surface irregularities. The final result may not be clear until 6 months after surgery.

Many people assume that because liposuction permanently removes fat cells, it's impossible to regain weight in the treated areas. This is only partially true. Adults have a fixed number of fat cells, and liposuction removes some of these cells permanently. The remaining fat cells can grow bigger, especially if you do not exercise and maintain a healthy diet. This means problem spots can return. However, weight gain after liposuction will usually be distributed to other parts of your body instead of settling back into the old problem areas.

Large-volume Liposuction May Also Improve Health.

Removing large volumes of fat via liposuction may not only improve a woman's appearance, but can also improve her health, according to a new report.

"Being overweight is not just unattractive, it's unhealthy," said Dr. Sharon Y. Giese, a New York City aesthetic surgeon who will report Thursday on the health benefits of large-volume liposuction for women at the annual meeting of the American Society for Aesthetic Plastic Surgery in Las Vegas, Nevada.

In the wake of problems with large-volume liposuction in the last decade, including some patient deaths, professional organizations discouraged its practice. However, doctors still perform large-volume liposuction for very overweight but motivated patients.

For two years, Giese followed the progress of 14 of her patients who underwent "large-volume" liposuction, typically defined as the removal of more than 5 liters of fat at a single session.

Women had fat removed from their back, flanks, abdomen and thighs, as needed. They reduced body weight and achieved reduction of high blood pressure and a reversal of diabetes-related problems. Giese speculates that the reduced body weight may also help ward off problems such as heart attacks.

This approach, Giese cautioned in an interview with Reuters Health, is intended only for women who are 30 to 50 pounds overweight, who have tried diet and exercise to no avail, and who meet other strict criteria. They must, for instance, agree to make substantial lifestyle changes, such as engaging in regular exercise and watching what they eat. She won't perform the procedure on patients with medical problems such as an eating disorder or uncontrolled high blood pressure.

On average, the women studied were 39 years old and had a body mass index (BMI) of 28.8 before the operation. BMI, a measurement based on height and weight, is used to assess obesity and evaluate optimal healthy weight. Adults with a BMI of 25 or higher are considered at risk for diseases related to excess weight, such as high blood pressure. A person who is 5'5" and weighs 150 pounds or 6'0" and 185 pounds has a BMI of 25, for instance.

At the 2-year follow-up, their average weight had dropped from 181 pounds to 170 and their BMI dropped from 28.8 to 27.2. Ten of the 14 had continued successful weight maintenance, defined for the study as the ability to maintain weight at least 5% lower than their preoperative weight.

The only complication was minor, Giese noted. One woman had fluid under the skin temporarily.

It takes about 6 weeks, due partly to fluid retention, to see full results. "A woman who was 40 or 50 pounds overweight 6 weeks later can expect to be 10 to 15 pounds lighter and two clothing sizes smaller," she says. The waist typically shrinks by 4 inches, and Giese added that may also translate to better health, since fat around the middle has been linked to heart disease.

The large-volume operation takes about 4.5 hours, Giese explained, and is done in a hospital under general anesthesia. She charges $8,000 to $16,000 for the surgery, hospital and other fees, depending on how much fat is removed and other factors. Typically, patients return to work in 1 week and can resume normal physical activity after 2 weeks.

Another aesthetic surgeon, Dr. Charles Hughes of Indianapolis, Indiana, who heads the society's body contouring committee, pointed out that only a handful of surgeons around the United States now perform large-volume liposuction, with most of the 385,000 liposuction procedures done annually involving less than 5 liters of fat removal.

Despite earlier problems with the procedure, the large-volume technique may make sense for selected patients, Hughes suggested, if done by an experienced surgeon. He plans to offer the technique, but only after staffing his office with an exercise physiologist and nutrition expert. Patients who are considering the operation should be sure their surgeon is well-trained in the technique and has performed several, he advised.

Breast Augmentation.

Consultation


At the initial visit, your doctor will likely ask you to describe in detail what you would like improved. Be specific about what you would like done. If your surgeon fully understands your expectations, he'll be able to determine whether your goals are realistic. Your surgeon will examine your breasts. He will talk to you about the size you want your breasts to be and other considerations involved with breast augmentation.

breast surgery pre-op preparation


Before Breast Surgery:
[ ] Do not take aspirin or anti-inflammatory medications (your doctor can provide you with a list of OTC medications to avoid)
[ ] If you smoke, quit smoking for at least 2 weeks pre-op (and anticipate no smoking for the recovery, smoking greatly increases your risk of complications)
[ ] Obtain a copy of your doctor's protocol
[ ] Make arrangements to have someone drive you to and from the operation
[ ] Arrange for someone to care for you the first 24-72 hours after surgery
[ ] Fill prescriptions (especially pain medications and antibiotics) before surgery
[ ] Consider a pill case with time chart for taking medications
[ ] Set up home recovery area: lots of pillows, books, magazines, journal, stationery, T.V., remote control, videos, favorite CDs
[ ] Black out windows so you can rest during the day
[ ] Whistle, bell, walkie-talkies or intercom system for requesting help
[ ] Prepare and freeze meals for 2 weeks
Consider quick snacks: Protein shakes, soup, applesauce, jell-O, frozen dinners, yogurt, oatmeal, cottage cheese, juice (purchase flexible straws for easier drinking)
Be sure to have adequate protein - the body needs it for proper healing
Talk to your doctor about low-sodium foods to reduce swelling
[ ] Prepare Icepacks (can also use packs of frozen veggies or fruit, gel packs, etc/) to reduce post-op swelling
[ ] Moisturizers, scar reducing creams and petroleum jelly for incisions
[ ] Laxatives (pain medications are often binding)
[ ] Eye Drops (after any surgery, eyes can be dry)
[ ] Consider hand-held shower head and bathroom chair
[ ] Telephone with speaker phone near your bed (turn off the ringer so it doesn't disturb you while you sleep; have answering machine in another room)
[ ] On the day of surgery, wear loose clothing which will be easy to get off and on after operation (a shirt that buttons in front)
[ ] Obtain a copy of the manufacturer's package insert for the breast implant you will receive. It contains information about precautions to be taken and risks associated with your particular implant. Keep it for future reference.
[ ] Obtain a copy of the manufacturer's device sticker. It identifies the brand of the implant you will receive, its size, and the manufacturer's lot number. This data should be part of your personal medical record. It will be useful if you should have problems following surgery or seek care from another health care provider.
[ ] Follow your physician's directions carefully regarding medications, eating & drinking, etc.

breast augmentation procedures/techniques


Anesthesia: General or Sedation
Location: Hospital, surgical center or office
Surgery time: 2-4 hours

Breast augmentation will enlarge your breasts. It will not improve nipple asymmetry, move breasts closer together, or lift droopy breasts. If you have droopy breasts, consider a breast lift (mastopexy). Breast augmentation is performed to balance a difference in breast size, improve body contour or as a post-surgery reconstructive technique. Silicone shells filled with saline solution are implanted either directly under the breast tissue or beneath the chest wall muscle, giving breasts a fuller and more natural contour.

Breast Implant shape
Round breast implants are not affected by rotation and cost less than teardrop implants. They do not require a textured surface. There are no disadvantages to round breast implants. This is the most common implant employed.

Teardrop breast implants were developed to provide a more natural look. They cost more than round breast implants and require a textured surface to prevent rotation. In the event that the implants rotate, it creates a distorted breast shape.

A recent study determined that a round breast implant takes on the same shape as the teardrop implant when standing. The study also concluded that when lying down, the round breast implant is more natural in appearance than the teardrop implant because it retains the teardrop shape and the round breast implant does not.

Breast Implant surface
Textured breast implants have an increased risk of rippling but a decreased risk of displacement. They also cost more (about $100). A recent study showed that textured breast implants have a higher deflation rate and are firmer than smooth implants.

Smooth breast implants have a lower risk of rippling, are less firm than textured breast implants. Any rotation of the implant will not affect the appearance. Smooth breast implants are used in 90% of operations.

Breast Implant size and volume
Breast Implants that are less than 350 ml have a lower risk of displacement, but may not provide the desired size.

Breast Implants that are more than 400 ml have a higher risk of displacement, but may provide the desired size.

Choosing your desired size can be a difficult decision. You'll want to decide your cup size and that will determine how large your implant will be. A 400 ml implant placed on a woman with an A cup will produce a C cup. The same implant placed on a woman with a B cup will produce a D cup. Bring pictures of your desired size (take a look at a lingerie catalog or swimsuit pictures) to your consultation. Take the time to decide what you'll be happy with so you don't feel the need to undergo a second surgery. You can also ask your surgeon for implant sizers to try on different breast implant sizes.

Be sure your surgeon plans to overfill the implants. This technique decreases the risk of deflation, rippling, and sloshing. There are no disadvantages to overfilling. Implants are meant to be overfilled, and the implant manufacturers recommend surgeons to overfill them.

Incision site
Inframammary incision: The incision is made on the lower portion of the breast, in the crease where the breast meets the chest, so that any scar will still be hidden. This incision allows your surgeon the best visibility during surgery. Most commonly done.

Periareolar incision: The second most common incision is made in the areola. The incision is usually a small semi-circle. The scar is camouflaged by the nipple. However, if there are any imperfections in the scar, it will be highly visible. This type of incision has an increased risk for diminished nipple sensation.

Axillary incision: The incision is made in the armpit, and may require the use of an endoscope. The scar is well-hidden, but provides poor visibility for the surgeon.

Umbilical incision: The incision is made in the belly button. It usually requires the use of an endoscope, and it is very difficult to place the implants below the muscle utilizing this method.

For faster recovery:
Keep ice packs applied to your chest on the day of your surgery.
Sleep in an upright position. Do not sleep on your stomach for the first two weeks after surgery.
To avoid unnecessary swelling or bleeding, do not bend over, strain, exercise or do any other activities that could increase pressure in your chest during the first week.
If you have smooth implants, massage them daily to keep them softer, avoid capsular contracture and keep them in proper position. Do not massage in the first 24 hours and do not massage textured implants.

These are general guidelines and our doctor can guide on a case to case basis.

Silicon Implant Approval.

Plastic Surgery Societies Applaud the FDA's Decision to Approve Silicone Breast Implants
For Immediate Release: November 17, 2006
Arlington Heights, Ill. (November 17, 2006) – The American Society for Aesthetic Plastic Surgery and The American Society of Plastic Surgeons, the two largest plastic surgery membership organizations, applaud the FDA's decision today to approve (manufacturer's) silicone breast implants and return these devices to the U.S. market. This decision comes 14 years after the FDA restricted access to the silicone implants because of safety concerns. “This is a great day for American women and the plastic surgeons who care for them,” said Roxanne Guy, MD, ASPS president. “Silicone breast implants have been scrutinized more than any medical device, and we applaud the FDA for making its well thought-out decision and allowing American women to make informed choices about their health care.”

Today's FDA decision follows a lengthy process in which the agency sent “approvable with conditions” letters to the two silicone breast implant manufacturers in the second half of 2005. The approvable letter stipulated a number of conditions that the manufacturers needed to satisfy in order to receive FDA final approval to market and sell silicone breast implants in the United States. These letters came after an FDA advisory panel hearing in April 2005, in which the panel heard more than 20 hours of data presentations from the manufacturers and public comment.

Approximately 300,000 women chose breast augmentation in 2005, according to ASAPS and ASPS statistics. Nearly 58,000 women had breast reconstruction in 2005, according to ASPS. Both breast augmentation and reconstruction have been proven in numerous studies to have psychological and physical benefits for women who choose these procedures.

The ASPS and ASAPS will continue to offer their assistance to the manufacturers for the conditions set forth by the FDA related to physician and patient education.

Capsular Contracture

Capsular contracture is one of the most common complications associated with breast augmentation. It occurs when the scar tissue hardens around the implant. It may be more common following infection, hematoma, and seroma. Capsular Contracture is much less common and less severe with saline implants than with silicone implants.

There are four grades of capsular contracture - Baker Grades I through IV.

The Baker grading is as follows:
Grade I - the breast is normally soft and looks natural
Grade II - the breast is a little firm but looks normal
Grade III - the breast is firm and looks abnormal (visible distortion)
Grade IV - the breast is hard, painful, and looks abnormal (greater distortion)

Grade I and Grade II require no treatment. Grade III is treated by reopening the incision and releasing the capsule. Grade IV requires repositioning the implant and may require implant removal. Capsular contracture may recur after additional surgery.

According to the FDA, in a clinical study of saline-filled breast implants conducted by Mentor, 9% of 1264 women with implants experienced Grades III and IV capsular contracture after 3 years of the study. In a similar study by McGhan, the rate was also 9% (of 901 patients). The rate of contracture in reconstructive patients is higher.

Another FDA study indicated that 17.5 % of 749 women had at least one surgical procedure over an average of 7.8 years because of capsular contracture.(1) This study included women who had implants for cosmetic and reconstruction purposes, most of whom had silicone gel-filled breast implants.

Dr. Jorges Planas, a plastic surgeon in Barcelona, Spain, conducted two studies on women with capsular contracture (a group of 52 women and a group of 24) and found an 83.8% improvement at 1-year follow-up following external ultrasonic treatment. On average, positive, long term results were achieved in less than 8 sessions. Ultrasound can also be used as a preventative method. You may want to discuss this treatment with your surgeon.

Implant displacement
Implants can move out of position at anytime after surgery. If they move only a little, it may not be noticeable. If they move a lot, you may need surgery to put them into position. This is very uncommon except in women who have very large implants. The larger the implant, the greater the chance that it will displace.

Infection
Infection is very uncommon. The risk is about 1% but if it occurs the implants will have to be removed. If infection does occur, it is usually within six weeks of surgery.

Necrosis
Necrosis is the dead tissue around the implant. This may prevent wound healing and require surgical correction and/or implant removal. Permanent scar and/or deformity may occur following necrosis. Factors associated with increased necrosis include infection, use of steroids in the surgical pocket, smoking, chemotherapy/radiation, and excessive heat or cold therapy.

Rippling
Rippling looks like indentations or waviness on the surface of the breast. It is the saline moving inside the implants. In most cases it occurs during movement. According to a 1994 survey (commissioned by implant manufacturers) 12% of women who were dissatisfied with their implants were dissatisfied because of rippling. Rippling is less likely to occur with implants that have a smooth surface. It is more common in implants that are placed above the muscle, especially in women with little or no breast tissue. Rippling can be a result of underfilling the implant.

Sagging
Sagging is less likely in implants placed above the muscle. Because the implant is likely to be higher on the chest than the breast tissue, you may have separate tissue hanging from the firmer implant. Your surgeon may recommend a mastopexy (breast lift) in addition to the augmentation.

Sensation Loss/Change
After surgery, you may have temporary or permanent numbness. There is also possibility of diminished sensation or increased sensitivity. The risk of having permanently numb nipples is roughly 15%.

Additional Surgeries
Additional surgery may be needed to replace or remove the implants due to problems such as deflation, capsular contracture, infection, shifting, and calcium deposits. Women who do not have their breast implants replaced may have cosmetically undesirable dimpling, puckering of the breast following removal of the implant, or other unsatisfactory cosmetic outcomes.

In a study of saline-filled breast implants conducted by Mentor, 13% of 1264 patients needed additional surgery after 3 years. In a similar study by McGhan, 21% of 901 patients needed additional surgery after 3 years.

Small breasts can be enlarged, large breasts can be reduced to a more proportional, comfortable size, sagging and shrinking breasts can be lifted.

Breast Augmentation




Breast enlargement is by far the most popular. The options of implants we use today are saline filled bag or upgraded new generation silicone implant that is totally harmless to your body. These implants are soft, supple, and available in different sizes and contours, they give a natural feminine feel and shape.

In addition, breast implants do not prohibit you from future breast feeding. The procedure itself takes about an hour and a half to perform and is done on an outpatient basis in the hospital. The implants may be placed either above or beneath the chest muscles or Dual Plane (new technique) depending on your build and special needs. Incisions are usually placed at the lower edge of the areola (the darker skin around the nipple), underneath the breasts or in the armpit using Endoscope (New Technique) - again depending on your individual needs

The incisions are closed with buried sutures that never have to be removed and give you the best possible wound healing. Most women following breast augmentation are back to work in five days.

Medicine and plastic surgery have advanced to the point where almost anyone's breasts can be readily changed in almost any manner. Small breasts can be enlarged, large breasts can be reduced to a more proportional, comfortable size, sagging and shrinking breasts can be lifted. And even breasts that have been removed during mastectomy procedures can be totally reconstructed to restore a full, natural, and beautiful figure. Virtually every problem can be addressed, and the benefits are obvious. The return of self-esteem. And confidence. A new figure. A new outlook. A new you!

Professional and Social - It has been shown in countless studies that more attractive people are generally perceived as more intelligent, more honest, more successful, and more capable. These same studies have shown correlations between attractiveness and professional recognition, hiring decisions, promotions, and differences in salary levels. Some studies have even shown that attractive people receive better and quicker service in restaurants and in retail establishments. This suggests that surgery to improve one’s appearance may indeed be a boon to one’s career and/or social status, especially when a person moves or works in creative or youth-driven industry.

The Risks

Health Risks - We begin with the most obvious of risks. Call it reconstructive, cosmetic, or plastic---it is still surgery. People have risked and lost their lives and limbs, and suffered devastating disfigurement and scarring as a result of plastic surgery gone wrong. The worst outcomes are rare, but risk is nonetheless a reality.

While each type of surgery has its own risks that are specific to that particular procedure, certain risks are common to virtually all surgical procedures. These risks include:

infection
excessive or unexpected bleeding (hemorrhage or hematoma)
blood clots
tissue death
delayed healing
anesthesia risks (including shock, respiratory failure, drug or allergic reactions, cardiac arrest, coma, death)
pneumonia
loss or change of sensation
need for secondary surgeries/dissatisfaction with results
paralysis or less severe nerve damage
Psychological and Social – How will you feel if your plastic surgery makes you fodder for gossip among your social circle? What if your partner exhibits signs of jealousy or insecurity because of your new and improved looks? Will you be totally comfortable with the increased attention you get with your newly enlarged breasts? What if you still feel “ugly” or inadequate after your “problem” has been surgically corrected?

The potential adverse psychological and social effects of plastic surgery have a lot to do with a patient’s pre-op expectations, and his or her pre-op mental and emotional state. It’s important to understand that while plastic surgery can bring positive rewards, it will not change your life, your problems, or your relationships. It is also important to understand that there is no such thing as physical “perfection”.

Unsatisfactory Results - Not every surgery is successful, and unlike most “medically necessary” surgery, the success of plastic surgery is quite subjective. Unsatisfactory aesthetic results (including contour irregularities, asymmetry, excessive or unfavorable scarring, etc.) can be disheartening or even devastating for some patients. Worse yet, the unluckiest of patients can be left with persistent pain, damage to vital tissues, or even nerve damage/localized paralysis.

Weighing it Out: Risks Vs. Rewards

The potential rewards of plastic surgery are highly individual. Many plastic surgery patients say their only regret is that they didn’t do it sooner. However, there are also many who wish they had never done it at all, or who at least wish they had done more research or chosen a different surgeon.

Of course, risk can be mitigated by doing your homework and becoming a very informed patient. Do not let price be the foremost determining factor in choosing a surgeon. Check credentials and references, ask lots of questions, and be on the look-out for red flags. Be sure that you go into surgery in the best health possible by taking care of yourself, and don’t let your desire for the surgery overshadow any serious health considerations.

While the risks of plastic surgery do vary from one procedure to another, certain risks are common to all surgery, and some of the risks are grave. Only you can decide if it’s worth it for you. Educate yourself. (About.com is a good place to start.) Take into account all the pros and cons. Talk it over with your loved ones.

If you decide to go for it, choose the best surgeon you can find. Follow his or her pre- and post-op instructions to the letter. Then enjoy your new look!

Lip Augmentation

Having juicy, moist healthy lips causes a lot of concern in the world of facial plastic surgery.

Just take a gander at the many sites featuring celebrity bad plastic surgery and see who is bravely facing the world with a set of overfilled or unbalanced kissers — commonly known as “trout pouts,” “fish lips” and “duck lips.”

Until now, the various ways lips could be augmented included:

Restylane
Juvederm
Living body tissue
Some surgeons remove fat from the patient and reinject it into the lips.

Inserts
A type of Gore-Tex is often implanted into scanty lips.

Another insert works like a breast augmentation — a thin implant is inserted into the lips and filled with saline.

But problems inevitably cropped up because:

Facial fillers are reabsorbed back into the body within six months
Replanted fat often dies if it cannot find a blood supply
GoreTex becomes hard after a few years and must be surgically removed
Fluid filled inserts implants can extrude, or pop out through the skin
Additional woes include crooked lips, bad reactions, unnatural feeling and appearance along with the formation of cysts.

So what are the lips challenged supposed to do?

It’s a universal and continuing problem because, with normal aging, sexy, lush lips on both men and women thin, becoming less plump and attractive. As a person ages, grooves on the upper lip also flattens while the red area, the vermillion, diminish and make the mouth not quite as kissable as in its salad days.

The latest wrinkle is removing neck muscle and grafting that tissue into lips.

The current issue of Journal of Facial Plastic Surgery, professional magazine for rejuvenation surgeons, tells of a two year test on 25 patients whose lips were augmented with muscle taken from the sides of their necks. Some connecting tissue, known as fascia, was also added.

The surgeons who came up with the technique examined their patients one and two years after the lip surgery.

Results? The amount of lip vermillion area had increased by 20 to 24 percent while the lips had become larger, too. A survey showed 24 patients were satisfied, with one patient requesting a little more augmentation with an injectable gel.

Now, a year later, yet another study on teen Lap Band users at the Royal Children’s Hospital in Melbourne Australia examined 50 “severely obese” patients, aged 14 to 18.

Why is that important? Good question!

Currently, the Lap Band is only approved in the United States for patients 18 and older. That means insurance companies are quick to inquire about exact ages when asked to cover a young patient who may be 100 pounds or more overweight.

(An extra 100 pounds on a five-foot-two teen boy or girl is very definitely not a good thing, regardless of what the insurance company says!)

If that patient is, say, 17 years and eleven months old, guess what? Right! Lap Band insurance does not kick in.

Lap Band doctors say that type of overweight often leads to other health woes, including:

Type II diabetes
High blood pressure
Sleep apnea
Heart disease
(Read more about Lap Bands)

The Australian teens were divided into two groups. One had the Lap Band implanted while the other group was hammered with information about diet, exercise and other healthy behavior changes. (Bet that went over really well with teens!)

Guess which group had lower weight after a year? Yep, the Lap Banders.

Columbia University also studied how 24 youngsters with body mass indexes (BMIs) over 40, aged 14 to 17, fared with a Lap Band. (A healthy BMI is 25.) After only six months, weight was down and the other associated diseases were starting to disappear.

But the most eye-opening results came from the study in Australia. Just take a look at these results:

Lifestyle counseling group: lost 6.6 pounds or 13.2 percent of excess body weight.

Lap Band group: lost an average 76 pounds or 78.8 percent of excess weight.

Here’s a no-brainer: which method would you choose?

The F.D.A. is currently studying the use of Lap Bands in patients under 18. Given the success of Lap Bands, we wonder which way they will swing? Think parents will still have to pony up to cover Lap Band costs?

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Many people still turn to cosmetic surgery because they want to look younger and better. However the risk is often not worth the procedure itself and/or can be prohibitively expensive. There are much safer (and cheaper!) natural and healthy alternatives. Here we look at the top five cosmetic surgeries and some healthy and natural alternatives.

2. Botox: More women want to get rid of the wrinkles that notoriously appear on the forehead and around the eyes than ever. Though these are common, particularly in women, there are more natural ways to go about preventing them from appearing in the first place. Staying out of the sun or at least using a protective sunscreen is one effective way. Another way is to stop squinting or wrinkling your brow line as that will only contribute to the problem. Again you can find some very effective creams and moisturizers that if used everyday can help to lessen the appearance of these tiny little wrinkles.

4. Face Lift: Again in the quest to constantly look younger or have fewer wrinkles, we see people heading to the cosmetic surgeon’s office for a face lift. This can certainly make you look younger, but can also look fake in some instances as well. Again staying out of the sun works wonders for keeping skin, especially on the face, looking younger and healthier. You can also find some excellent aging creams that will reduce the appearance of wrinkles and keep you looking and feeling young.

Q. Osteoarthritis is more common in younger men and strikes women at older ages. Why?
A. Osteoarthritis is thought to be more common in men in their younger years because of trauma — meniscal tears, sports-related injuries. And then it shifts over to women as aging and obesity take over — the big risk factors in women. It is probably in the mid-40s to mid-50s that it transitions.
Q. Are menopause and decreased hormone levels to blame?
A. Osteoarthritis is more common in everybody as we get older. But in the knee and some of the joints in the hands, it is more common in women than in men. Whether that's hormonal or not is controversial; there are some studies suggesting that lack of estrogen is a predisposing factor for it, but that's not corroborated in other studies. So I think that still needs further study, whether hormones are really playing a role or not. Some people have argued that women's thighbones come off at a sharper angle from the wider pelvis, and that that may be a contributor as well. It might not be hormonal.
Q. Is it possible to know whether someone is at risk for osteoarthritis?
A. Most of the risk factors that have been studied are knee-related, and most of the risk factors for knee osteoarthritis are relatively weak. We don't have an overwhelming array of risk factors that really tell us who's going to get it. And it's so common as people age -- that's far and away the biggest predictor.
Q. Do women and men develop osteoarthritis in different joints?
A. Men get it in the hip a little bit more than women; women get it in the knee more than men. Hand osteoarthritis is more common in women as well, in what we call the distal joints at the very end of the fingers. But, of course, the entire spine can be affected by osteoarthritis, and the big toes, which form bunions. There's this reigning theory that bunions are a problem for women who wear tight shoes. But whether that's really ever borne out in data, I don't know. I see a lot of men with bunions, too. The spine is pretty equal: just about everybody who reaches 70 or so — or even younger — is going to have osteoarthritis of the spine in some area. And most of those are going to have some degree of osteoarthritis in the knee as well.
Q. How has the aging of the boomer generation affected osteoarthritis care?
A. Well, first of all, it's the aging process plus obesity. People are living longer and are more obese, so it's affecting people at both ends of the age spectrum. They're living long enough so that everybody's getting osteoarthritis; and then because of obesity starting so early, we anticipate that people are going to start developing osteoarthritis at a much earlier age. So that where one might have had 10 or 20 years of osteoarthritis in the knee, maybe now what we're going to see is 30 or 40 years. And I don't think we know the full implications of this yet.
Q. Are you seeing more knee replacements?
A. We definitely are seeing increasing numbers of people coming in for knee replacement. And revisions: if people live longer with their osteoarthritis, they're going to need total knee replacements earlier. How many times can you revise a knee replacement? If somebody gets her first knee replacement at 40 instead of 60, and the replacement lasts about 10 or 15 years, is there enough good bone in the system to be able to have three and four and five revisions? I think the health-care costs are going to be astronomical, from a surgical point of view, because we still don't have any good treatment for this illness.

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