Below is an abridged version of some of the sections from my book, "100 Questions and Answers About Plastic Surgery." For more information, you can pick up a copy of the book by clicking the link in the box below.
- Why should I consider plastic surgery? >>MORE
- What are realistic expectations? >>MORE
- What defines a qualified plastic surgeon? >>MORE
- What questions should I ask about my physician's qualifications? >>MORE
- Where is plastic surgery performed? >>MORE
- What is involved in a consultation? >>MORE
- What will plastic surgery cost? >>MORE
- What are the risks of plastic surgery? >>MORE
- What is plastic surgery of the breast? >>MORE
- What is liposuction and how can it reduce fat? >>MORE
- What is a tummy tuck? >>MORE
- Can sagging skin be corrected with plastic surgery? >>MORE
- What is plastic surgery of the facial structure? >>MORE
- What is rhinoplasty? >>MORE
- What are facial implants? >>MORE
- Can protruding ears be corrected? >>MORE
- Can plastic surgery reduce the signs of aging? >>MORE
- How can baggy eyelids be corrected? >>MORE
- What is a brow lift? >>MORE
- How is an aging face or neck improved? >>MORE
- What are minimally invasive procedures? >>MORE
- What is Botox®? Can it help stop my wrinkles or soften them? >>MORE
- How can I soften creases and wrinkles, or enhance the fullness of my face? >>MORE
- What is laser resurfacing? >>MORE
- Can the signs of plastic surgery be camouflaged? >>MORE
- Can procedures be repeated? >>MORE
1. Why should I consider plastic surgery?
If you have a physical need to restore a more normal appearance and function, then you should consider reconstructive plastic surgery. If you want to enhance what is otherwise considered a normal human feature, then you should consider aesthetic plastic surgery. This includes both procedures that reverse or improve the signs of aging (rejuvenation surgery) and those that enhance appearance.
No one can or should tell you why you should consider plastic surgery for aesthetic reasons. You should be able to clearly define your desire to improve aging or to enhance your facial or body appearance. Others may support you in your decision, but the decision to have plastic surgery should be yours alone.
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2. What are realistic expectations?
Realistic expectations include: (1) a complete understanding of the plastic surgery process and (2) accepting that process as necessary to achieve realistic goals.
The process of plastic surgery, like any medical treatment or surgery, involves:
- Pretreatment or preoperative patient obligations
- Varying degrees of discomfort, anxiety, and pain
- Time commitment for the procedure and recovery
- Post-treatment and postoperative patient obligations
- Potential for unfulfilled goals and possible undesirable results
- Potential for physical risk
- Financial obligation
The difference between aesthetic plastic surgery and other medical treatments is that you are undergoing treatment by choice. Aesthetic treatment is not performed to promote better health. It involves a personal, emotional and physical investment. You cannot expect to be fully satisfied by plastic surgery-even if the actual physical outcome was what you expected-unless you are prepared fully for the process that outcome will require.
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3. What defines a qualified plastic surgeon?
In the U.S., qualified providers of plastic surgery procedures are those physicians with board certification that is recognized by the American Board of Medical Specialties (www.abms.org). Board Certification, in many cases, is a very complex and thorough process that takes several years after completion of medical school and includes formal training as a resident in one or more surgical specialties. The ABMS recognizes only one plastic surgery board, the American Board of Plastic Surgery (www.abplsurg.org). Only those holding ABSP certification can appropriately hold the title of “plastic surgeon.”
(To review my credentials, please click here).
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4. What questions should I ask about my physician's qualifications?
As a potential patient, you must take the initiative to find out whether a particular physician is qualified to perform plastic surgery procedures.
Questions to ask include:
- Is this doctor board certified in plastic surgery or a specialty related to the procedure I am considering?
- Does this physician have recognized post-graduate training?
- What credentials has this physician achieved?
- Does this physician have sub-specialty training, credentials or certificates?
- How often has this doctor performed the procedure I'm interested in?
- What have the outcomes been with other patients treated by this physician?
5. Where is plastic surgery performed?
Plastic surgery can be performed in any number of places. Noninvasive procedures are most commonly performed in a physician's office examination room. More invasive procedures should be performed in a hospital or ambulatory surgical facility. An ambulatory surgical facility is an office-based or freestanding surgical setting. Any facility where invasive surgical procedures are performed must be fully accredited by a nationally recognized organization and/or be state licensed. This is essential for your safety.
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7. What is involved in a consultation?
The consultation process varies from surgeon to surgeon. Generally, you will meet with your plastic surgeon during the consultation. Many physicians also have patient counselors or nurses who will guide you through the consultation process. However, none of these individuals should ever be a substitute for meeting the physician who will be treating you.
Most consultations begin with discussing your medical history, and short-and long-term goals for plastic surgery. You will be asked specifically about what you wish to accomplish, and you will be informed about the treatments that can achieve your goals. You will also see (or should ask to see) photographic results of your recommended procedure(s) performed by your surgeon.
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8. What will plastic surgery cost?
In general, insurance will only cover reconstructive procedures. Aesthetic procedures tend not to be covered, although there are exceptions. In either case, it's important to get pre-certification from your insurance provider for any procedure so you always know where you stand financially (most physician's offices will help you with pre-certification).
Your financial obligations will depend on the procedure planned, your geographic region, your surgeon's fees, and where the procedure will be performed. You will be given a specific breakdown of the cost of any procedure based on surgeon's fees, the fees for anesthesia and fees for special medical devices (such as special post-surgical garments). You may also need to pay for preoperative lab work, although lab work may be covered by your insurance.
If you choose to recover in a special postoperative recovery facility, the cost of this, too, should be specifically itemized. This includes everything from your room and board to basic care, amenities, and added services that make your stay more comfortable. These services are your choice, and you have the right to know upfront what those costs will be.
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9. What are the risks of plastic surgery?
The risks of plastic surgery begin with those of any surgical procedure: bleeding, infection, pulmonary emboli (blood clots), anesthesia complications and unexpected complications related to individual procedures.
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11. What is plastic surgery of the breast?
Plastic surgery of the breast, much like any plastic surgery procedure, can be reconstructive (to restore a more normal appearance) or aesthetic (to enhance appearance).
You should know that plastic surgeons certified by the American Board of Plastic Surgery are the only qualified providers of plastic surgery of the breast. No other specialty has dedicated training specifically in plastic surgery procedures of the breast.
Aesthetic breast procedures include:
- Breast lift to reshape and reposition flattened breasts that hang low
- Breast augmentation to increase or enhance the size of breasts
- Breast reduction to reduce breast size for improved appearance only
Reconstructive breast procedures include:
- Post-mastectomy reconstruction to rebuild or restore a breast that has been surgically removed or disfigured by complete or partial mastectomy
- Breast reduction to reduce the size of overly large breasts, in disproportion to a woman's body, causing pain and discomfort
12. What is liposuction and how can it reduce fat?
Liposuction, also called lipoplasty or suction lipectomy, is surgery that uses vacuum suction and special instruments to remove localized, subcutaneous fat deposits. Subcutaneous refers to the fat that exists immediately below the skin and above muscle. Familial fat deposits are those caused by heredity and that remain despite diet and exercise. Fit individuals with familial fat deposits are good candidates for liposuction. Liposuction also improves body contours in people who simply have disproportionate fat deposits in specific localized areas. These areas generally include:
- Fat in the neck that gives the appearance of a chin that disappears in the neck or a double chin
- A lower body that is out of proportion with the upper body
- Tummy, hips, thighs, buttocks, knees, ankles or upper arms that have disproportionate bulges and irregular contours
- Male breasts that appear almost woman-like, having excess curves
13. What is a tummy tuck?
A tummy tuck, also called abdominoplasty, improves the contours of the abdominal area to produce a flatter, more toned appearance. Tummy tuck corrects more than a bulge; in cases where your waistline has disappeared or folds over, a tummy tuck can produce a flatter, more trim abdomen. Tummy tuck is not a substitute for fitness or weight loss. The procedure corrects excess skin in the abdomen and may tighten the abdominal muscles. It may also remove a small amount of fat. The conditions suitable for treatment with abdominoplasty may:
- Be localized to the lower or central abdomen
- Involve the entire abdomen
- Involve the entire abdomen and extend to the back
14. Can sagging skin be corrected with plastic surgery?
Body lifts are surgical procedures performed to correct excess loose, sagging skin and underlying fat that exists anywhere in the torso or extremities. (Tummy tuck, described above, is a surgical body lift procedure specific to the abdominal area.) A body lift reshapes the body contours and removes sagging skin.
Surgical body lifts correct conditions that result from aging, weight loss and multiple pregnancies (with associated weight gain and loss). In some cases, the conditions that are corrected by body lifts may be hereditary: familial fat deposits and skin that lacks tone and elasticity. Surgical body lifts can result in a dramatic improvement in the condition and appearance of your contours and skin.
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15. What is plastic surgery of the facial structure?
Facial structure is determined primarily by bone and cartilage; facial appearance is determined by facial structure as well as overlying soft tissues (muscle, fat and skin). Facial structural change is plastic surgery that reshapes bone and cartilage as well as the overlying soft tissues. Surgical techniques or the use of implants improve the size, shape, angle or contour of the nose, chin, jaw, ears and cheeks.
Facial structural surgery can produce very subtle to very dramatic changes in appearance. Understand that the results of plastic surgery to change facial structures are permanent and can only be modified through additional surgical procedures. Therefore, you must be confident in your desire for a given change in your facial structure as well as in the surgeon you choose and his or her recommended course of treatment.
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16. What is rhinoplasty?
The nose is the most defining feature of the human face. Rhinoplasty is surgery of the nose performed to improve appearance and often function. Where surgery is performed to improve breathing function, pre-certification is required for insurance coverage. Rhinoplasty performed solely to enhance appearance is aesthetic and therefore, no insurance coverage is available.
Aesthetic rhinoplasty can accomplish any or all of the following:
- Revision to the nasal bridge-correction of humps or depressions, adjustment of a broad or narrow bridge
- Revision of a nasal tip-reduction of a bulbous tip, changing the angle of the tip or augmenting a poorly projected tip.
- Reshaping nostrils, including reduction of enlarged nostrils
- Revision of multiple features of the nose including the size, angles and curves of the nose in relation and proportion to other facial features
The most common functional procedure of the nose is correcting a deviated septum. A deviated septum can cause breathing impairment. Correction requires removal of a portion of the septum and then repositioning it.
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17. What are facial implants?
The nose may be the most prominent facial feature, bit it's the structure of the face as a whole that forms your overall appearance. To achieve facial harmony, facial implants may be helpful to change the size, contours and angles of the cheek (submalar and malar) region, or the chin and jaw.
Facial implants are typically formed of medical-grade solid silicone or other solid substances that can be safely used in the human body. They are specially shaped and sized solid structures that can be implanted into the face, much like an artificial joint can be implanted in the body with orthopedic surgery.
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18. Can protruding ears be corrected?
Surgery to correct prominent or protruding ears is called otoplasty. Although otoplasty is more often performed on children, adults frequently undergo the procedure to improve appearance that may have bothered then since childhood. Otoplasty can improve the aesthetic appearance of protruding ears to create a more natural contour and softer appearance.
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19. Can plastic surgery reduce the signs of aging?
Plastic surgery can slow the changes aging produces in our appearance. Facial rejuvenation surgery is one of the most rapidly growing categories in plastic surgery, and includes procedures that essentially restore a more youthful appearance to the individual.
Rejuvenation procedures target the specific signs of aging in all areas of the face and neck. These can be performed individually or with multiple procedures in one or more surgical sessions. The procedures include:
- Eyelid surgery: to restore a smooth contour to the upper eyelid, and/or correct bagging of the lower eyelid
- Brow lift: to raise a drooping brow and/or smooth furrow in the forehead region
- Face lift: to restore and smooth contours to the midface, jowls and neck
- Autologous enhancement: using your own tissue to augment facial areas
- Non-autologous enhancement: using tissue or implants from other sources to augment facial areas
20. How can baggy eyelids be corrected?
The appearance of saggy eyelids at any age can make a well-rested person look tired and a happy person look sad or even angry. Eyelid surgery (called blepharoplasty) improves the appearance of the upper and/or lower eyelids by restoring or creating a smooth upper eyelid contour or correcting excess dropping or puffiness (bags) in the lower eyelid. Eyelid surgery does not change the position or nature of the eyebrows. (The procedure to correct these conditions is a brow lift.)
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21. What is a brow lift?
A brow lift is surgery to improve or reposition a low, hooded brow, as well as vertical “frown lines” that develop above the bridge of the nose between the eyes. A sagging, furrowed forehead and brow that develop with aging can make a content individual appear angry or scowling, and a well-rested individual appear tired and drawn. Brow lift restores a more youthful and alert appearance to the brow region.
Often, people ask for eyelid surgery when a brow lift more accurately corrects their conditions. Raising a drooping brow can somewhat improve the appearance of the upper eyelid. But brow lift alone does nothing to change the contour of the upper eyelid and eyelid surgery does not raise a drooping brow. Frequently, both procedures are performed together to create a soft, well-rested appearance to the upper eyelid and brow.
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22. How is an aging face or neck improved?
A facelift (rhytidectomy) is rejuvenated plastic surgery of the mid-face region, the lower face, including the jowls and the neck. Rhytidectomy lifts and smoothes the skin of the face and neck. A facelift restores a softer, smoother, more youthful appearance. Following a facelift you should appear more rested, uplifted and happy as opposed to looking tight or “done.” You also will look like a much younger version of yourself.
Specifically, a facelift softens and improves:
- Saggy, loose jowls that may result in a poorly defined jaw line or one that disappears into the neck
- A sagging neck that may appear as a double chin
- Vertical banding or chords that develop in the neck
- Nasolabial folds (the creases that extend from the corners of the nose to the mouth)
- Marionette line (the creases from the outer corner of the mouth to the chin)
23. What are minimally invasive procedures?
Minimally invasive procedures are those treatments that address the skin and underlying tissue without major surgical intervention. While minor in scope, these procedures can make a very visible improvement in your appearance. They fall under three specific categories:
- Injection therapies that change soft tissue function, namely Botox® Cosmetic therapy to soften existing wrinkles and facial folds
- Soft tissue augmentation (enhancement) with substances that are either injected or placed through limited surgical techniques (including pharmaceutical and your own tissues)
- Skin resurfacing techniques, including mechanical resurfacing, chemical resurfacing and laser or light-based procedures
These procedures offer high patient satisfaction, a lower cost compared to traditional plastic surgery and a relatively shorter recovery period. However, there are a few things you should understand:
- The results are not the same as those achieved with surgical procedures
- Although they are non-surgical in most cases, they are, nonetheless, medical procedures that do carry a potential for risk
24. What is Botox®? Can it help stop my wrinkles or soften them?
Botox® is the brand name of a drug formulated from the natural proteins of the botulinum toxin type A. Botox® Cosmetic is the form of this drug labeled and used for aesthetic reasons.
Botox® specifically produces:
- A softening of the facial creases and folds that result when certain facial expressions are made
- A restored balance in cases of facial asymmetry due to unequal muscle action or inaction in the face
Botox® injection is a very safe procedure in trained hands. Be careful when marketing messages of cheap treatment and deep discounts are given. Sometimes you may end up with highly diluted concentrations of Botox® that won't produce good outcomes, or it may leak to other areas and cause muscle weakness in the wrong place.
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25. How can I soften creases and wrinkles, or enhance the fullness of my face?
Soft tissue fillers (like Restylane®) are used to fill or soften irregular contours in the skin, or to create or restore volume underlying soft tissue. Fillers are technically implants or grafts used to enhance or modify the soft tissues, most commonly of the face. The variations include:
- Injectable pharmaceutical fillers
- Implanted pharmaceutical fillers
- Your own tissue (fat, dermis or fascia) injected or implanted
In general, soft tissue fillers are used to:
- Fill fine lines, wrinkles and deeper creases in the skin
- Restore or create fullness in the soft tissues under the skin
- Enhance lips
- Improve the appearance of recessed or concave scars
Much like Botox®, injectable pharmaceutical fillers are readily available, and there are many unqualified providers offering treatment. So be sure to choose an appropriately trained, board certified provider, namely a plastic surgeon, facial plastic surgeon or dermatologist. Also, accept treatment only of a brand-name injectable drug or filler substance that is approved in the United States by the FDA.
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26. What is laser resurfacing?
Laser resurfacing is a procedure that uses laser technology to ablate (remove) the outer layers of the skin. Ablative lasers are direct beams of light move over the skin's surface to destroy some cells. This allows for regeneration of new cells and creates a fresher, smoother appearance.
Use of an ablative laser, in controlled depths, can improve many surface conditions of the skin:
- Erase fine lines on the skin surface
- Soften deeper wrinkles and facial creases
- Reduce irregular pigment and brown spots
- Improve uneven, blotchy appearance of the skin
- Improve the condition of uneven, scarred skin
- Tighten thinner skin that has lost elasticity, including lower eyelids
27. Can the signs of plastic surgery be camouflaged?
Facial Procedures
In the first few days following any surgical facial procedure, large-framed sunglasses, a fashionable scarf or even a hat can be a good camouflage. In the following days, there are some very specific cosmetics available to hide the bruising or discoloration you may experience. Your plastic surgeon may provide you with camouflage cosmetics, or you may wish to visit the cosmetic counter in a department store or salon. It is sometimes helpful to experiment with camouflage products prior to surgery. But don't use cosmetics on any open wounds postoperatively.
Breast Procedures
The easiest camouflage for breast procedures is a simple button-down blouse or shirt, or a zip-front sweatshirt. You won't want to be pulling anything over your head in the first few days after surgery. A shirt, even one that is more fitted, will easily conceal a support bra or any swelling. Shop for and set aside a few of these items and a few support bras prior to your surgery. Cotton bras are generally more comfortable during healing, as is a front closure. Make certain you don't purchase bras or support garments with underwires until you are advised you may wear them.
Body Contouring Procedures
With any body contouring procedure, loose-fitting clothing can easily camouflage any swelling. If you have a procedure that significantly reduces the size of your body, shop for some clothing in varying sizes before your procedure. Just make sure that any items you don't wear can be returned.
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28. Can procedures be repeated?
We know that patients may undergo “revisional” surgeries for minor problems, such as thickening scars or slight asymmetries. Additionally, the human body continues to age. Therefore, after a period of time, changes will occur in the face and body that may warrant further surgery to achieve more youthful contours. Facial rejuvenation, for instance, will bring you back about 10 years, but 8 to 10 years after surgery you will see aging that may warrant further surgery. Undergoing another procedure at this time can be very helpful to maintain your more youthful and smooth appearance. It's a good idea for you to know your options for long-range maintenance before you begin treatment.
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