Spotlight on Cosmetic Surgery

Cosmetic surgery has experienced growing popularity over the past 15 years. With less-invasive techniques, procedures that require little or no downtime for patients and greater affordability, cosmetic surgery has become a preferred alternative that addresses people’s desires for both improved appearance and health. Affordability and fast recovery time drive am increase in cosmetic rhinoplasty.

Whether it’s for a better appearance or to correct a functional problem, the number of people seeking rhinoplasty is on the rise, according to William E. Silver, M.D., a triple board certified facial plastic surgeon with Atlanta Institute for Facial Aesthetic Surgery.

“The cosmetic aspect of rhinoplasty has increased for several reasons. For example, we now have outpatient surgery centers that offer this type of surgery, which means that hospitalization is no longer required; therefore, the cost has dramatically decreased,” Dr. Silver says. “Additionally, patients can undergo relatively complicated procedures as outpatients at these centers, with improved anesthesia management and faster recovery time. There has also been an increase in the number of people of various ethnic origins who desire surgery to create a different or softer appearance.”

With respect to functional nasal surgery, Dr. Silver says that more and more patients are realizing that they can achieve two goals at one time.

“They can undergo functional and cosmetic procedures in just one surgery,” he says. “I believe this option has contributed to the increase in people seeking cosmetic rhinoplasty.”

Dr. Silver adds that advances in technology and non-surgical treatments and techniques have improved rhinoplasty procedures.

“We now have instrumentation that makes it relatively easy to do suturing inside the nose. There is no longer a need for all the nasal packing that we used to do in order to hold nasal structures in place,” he says. “Another advance is the use of computer imaging, which has helped tremendously as a communications tool. We can use the technology to define and compare the patient’s desires with the surgeon’s goals so that they are ultimately matched.”

For women who want to get their bodies back after having babies, “mommy makeover” surgery is ideal, says Bernadette Wang Ashraf, M.D., a board certified plastic surgeon with Artisan Plastic Surgery. The surgery, which actually involves two procedures — one to enhance/restore the breasts and the second to repair the abdomen — has grown steadily in popularity over the past 15 years, according to Dr. Ashraf.

“In my practice, I have seen a definite increase in patients seeking the mommy makeover. I think the main reason for its popularity is that so many women are healthy, with good diets and exercise routines, but are still frustrated with some of the changes their bodies go through after pregnancies,” she explains. “No amount of diet or exercise can perk up breasts or remove excess abdominal skin or repair abdominal muscle separation — but the mommy makeover surgery can. And it is done safely with great results.”

The most common surgery for enhancing and restoring the breasts in the mommy makeover is breast implants, with or without a breast lift. Since breasts commonly deflate after pregnancy, the implants help to restore their volume. However, some patients have enough breast tissue that can be used to lift and reshape the breasts, thereby eliminating the need for implants.

The most common procedure to repair the abdomen after pregnancy is a “tummy tuck,” or abdominoplasty, in which excess skin and fat is removed and rectus muscles are repaired.

Dr. Ashraf says there are several benefits to having both breasts and abdomen addressed during the same operation.

“First, the patient undergoes just one surgery, so there is only one anesthesia and one recovery period. There is also a slight cost advantage when combining procedures,” she says. “By addressing both the breasts and abdomen at the same time, the result is that the patient feels like the upper and lower part of her chest and torso match, with much better proportions.”

Dr. Ashraf says that the main recovery period for a mommy makeover is about two weeks, but adds that most patients feel it takes up to six weeks for full recovery and that it may take months for all swelling to subside. And she cautions that not every woman is a good candidate for the surgery.

“This surgery isn’t appropriate for anyone whose overall health is not good,” she says. “Furthermore, it’s not a substitute for proper diet and exercise, and it is not a surgery for weight loss. We strongly recommend that a woman be within 20 percent of her ideal weight in order to get the best results.”

Alexander S. Gross, M.D., medical director of Georgia Dermatology Center, is double board certified and experienced in treating all aspects of advanced medical dermatology. He says that the biggest upward trend in surgeries in his practice are tumescent liposuction and short incision facelifts, both of which have experienced improvements as well as lower costs in recent years.

“I’ve been doing liposuction for close to 20 years now, but I haven’t raised my prices in 20 years,” he notes. “I think you can attribute that lack of increase in price to advances in equipment and technology, such as smaller cannulas and power-assisted devices that reduce the trauma of the procedure and allow us to complete it more quickly.”

Dr. Gross adds that short incision facelifts, commonly referred to as “lifestyle lifts,” are increasingly popular because they offer the advantages of fast recovery time and affordability.

“The short incision facelift involves a few sutures that can usually be covered by the patient’s hair and allows him or her to return to work and active life within a couple of days. It’s less costly than a full facelift,” he says. “However, the longevity of the procedure is not equivalent to having a full facelift. So the patient has to weigh cost and recovery time against longevity.”

Another trend in dermatology, and not a good one, is the increase in incidence of skin cancer in the U.S., most notably in younger people, says Dr. Gross.

“I probably spend 50 percent or more of my day diagnosing skin cancer. It’s an epidemic,” he says. “The particularly scary thing is that incidence of melanoma has doubled in the last 20 years, and we’re seeing more and more cases in children and adolescents.”

Dr. Gross attributes this increase to the use of tanning beds as well as lack of use of sunscreens.

“People have a perception that tanned skin is pretty skin, so many think tanning beds are a safe way to get it,” he explains. “What they don’t realize is that people who use tanning beds have a 70 percent chance of getting melanoma in their lifetime.”

Dr. Gross says that physicians, especially primary care physicians and pediatricians, can help reduce the incidence and impact of skin cancer by incorporating a skin exam into their patients’ regular physicals and giving warnings about tanning beds and using sunscreens with UVA and UVB protection.

“It doesn’t take much time to examine the skin while you’re doing other things, like listening to the patient’s heart and lungs or examining their eyes, ears, nose and throat,” he says. “Familiarize yourself with what different types of skin cancers look like, and don’t be afraid to refer your patient to a dermatologist if you even have a grain of suspicion that something doesn’t look right. Going forward, skin cancer will continue to be a huge issue, and primary care physicians can be at the forefront of diagnosing it.”