Plastic surgery can help a person to look and feel better, but, like any operation, it shouldn’t be taken lightly. NWQ speaks with three local experts on what you should know before you go.
Along with diet, exercise and change of habit, people often consider plastic surgery to help them look and feel their best. Personal relationships, career advancement and self-esteem are some of the motivating factors that prompt people to change their images.
Breast augmentations, lifts and reductions are among the most popular plastic surgery procedures. Dr. Sarah Hagarty, a plastic surgeon with offices at 698 Featherstone, Rockford, does many breast surgeries every month, both cosmetic and reconstructive after cancer. The frequency for cosmetic procedures is often cyclical.
“Spring is a busy time for breast enhancements, because patients want to have it done early and be ready for summer,” Hagarty says. “Fall can also be busy, because patients want to have the procedures done and healed before the holiday season starts. For surgeries covered by insurance, there’s often a mad dash toward the end of the year.”
Patients often come to Hagarty for breast enhancement because of a desire for better all-over body harmony and balance. Very thin and otherwise healthy patients often have smaller breasts, and a small breast size is something that can’t be improved with exercise. Another common time for considering augmentation is post-pregnancy and childbirth.
“Women in their 30s and 40s, who have finished bearing children, have undergone many fluctuations in body shape, which can take a toll on breast appearance,” Hagarty says.” Breasts can lose volume or sag, become flatter and more droopy. A patient may feel older or less desirable because of her breast shape.
For any breast enhancement, there are many approaches. The procedure can be done in the subglandular plane, just underneath the breast, or submuscularly, under the pectoralis. Breast shape, workout habits, skin quality and implant preference are all factors that must be considered.
“If the patient is very thin, or saline implants are desired, it’s necessary to go under the muscle,” Hagarty explains. “There are benefits with either technique, but I always want to do what’s best for the given patient on an individual basis.”
With over-the-muscle procedures, patients experience significantly less pain and a faster recovery time, often as short as a weekend. Surgery beneath the muscle is more painful and requires a longer recovery period. Patients must minimize certain activities and may experience swelling and discomfort for up to two weeks after surgery. Also, patients who are bodybuilders, for example, have thicker muscle mass, which can force implants to move laterally, creating a disturbingly wide placement of the breasts over time. These patients often do better with a simple subglandular placement.
“We have many more options today, especially now that the gel implants are back, which better enable us to tailor treatments to each patient,” Hagarty says.
Concerning breast reductions, the goal is not always just cosmetic.
“Insurance companies may cover breast reductions when breasts are so disproportionately large that they cause back, neck and shoulder pain for patients, or skin rashes under the breasts,” Hagarty says. “These can seriously affect not only self-image, but also quality of life. If physical therapy to help reduce pain proves ineffective, we move on to surgery.”
Several factors need to be considered with breast reduction, including a patient’s height and weight, and the amount of tissue to be removed.
Various breast treatments are sought by patients as young as late teens and early 20s, quite legitimately, Hagarty says.
“Breasts can be congenitally deformed or abnormally sized, with one being even two cup sizes smaller than the other,” Hagarty says. “This can seriously impact self-confidence, especially for students who experience tremendous distress in physical education classes where they have to undress in the showers. Augmentation or reconstruction may be required, to achieve reasonable symmetry or to correct severely deficient or misshapen breasts, also known as ‘tubular breast deformity.’ This can make a world of difference in self-esteem.”
Hagarty adds that one of her pet peeves is insurance companies that don’t cover this type of surgery and label it simply as cosmetic.
“So many are not sympathetic when it comes to this type of surgery, and fail to understand the level of psychological and social stress these young women endure,” Hagarty says. “For me, the most important aspect of any breast surgery is how it makes the patient feel. I want them to feel whole and good about themselves.”
“Mommy makeovers usually involve breast enlargements or lifts combined with tummy tucks and/or liposuction,” Georgis explains. “These torso-contouring procedures can be done in one surgical session so each flows into the other. I do mommy makeovers at least once a week.”
While liposuction is often perceived as a separate procedure, Georgis points out that it is a logical part of body contouring.
“I look at it as a tool that enhances neck, face and breast lifts as well as tummy tucks,” he says. “Nearly all of my patients receive liposuction to some extent, because it helps me to properly contour skin, muscle and fat for an optimum outcome.”
What is unusual is that Georgis performs mommy makeovers not only on new mothers in their 20s or 30s after their milk dries up, about six weeks after giving birth, but also on women in their 40s through 60s.
“Mommy makeovers are all done on an outpatient basis in our office,” Georgis says. “This requires about four hours, the magic number for outpatient surgeries. What I like about this is that the work is done on one physical field and flows together. Of course, the procedures can also be done separately, depending on the patient’s health and financial condition. It’s more cost-effective to do it all at once, because it saves surgical suite set-up plus other doubled expenses.”
Recovery time for mommy makeovers is about two to three weeks. Patients should be able to drive after the first week or so, and resume work and exercise routines in about four weeks. Before the surgery, every patient has a comprehensive physical and at least a one-hour consultation in his office.
“It is surgery, and as such, has all the same risks of any surgical procedure,” Georgis emphasizes. “The advantage is that I am almost always operating on healthy patients, which lowers those risks. We spend time translating what the patient wants into action. We talk about risks, benefits and alternatives, so the patient can make an informed decision. I believe informed consent beforehand trumps excuses afterward.”
Georgis has refused to operate on certain patients, primarily because they appear to have unrealistic expectations of what the plastic surgery will achieve. And, he adds, it is possible to overdo a good thing.
“Depending on the situation, I refer them to their family doctor or a psychologist,” he says. “Unfortunately, they sometimes find a surgeon who will do the procedure. Sadly, we see a lot of this happening. The bottom line is that I make my living on successful surgeries, and my reputation on knowing when to refuse.”
Repeat procedures, such as face-lifts or breast enlargements and lifts, are usually done only after a significant amount of time has passed, depending on the individual and the outcome of the primary surgery.
Georgis highly recommends going only to plastic surgeons who are not only board certified, but board certified by the American Board of Plastic Surgeons, whose code of ethics is designed to protect patients from becoming victims.
“Make certain that the surgeon is certified and his or her operating room is an accredited facility,” Georgis advises. “Just saying board certified doesn’t cut it.”
Because plastic surgery carries all the risks of other surgeries, plastic surgeons emphasize the need for patients to use caution and common sense when choosing to have a procedure done.
Weiskopf considers some newer methods to be bizarre, such as using string with hooks as a face-lift technique. Then there is the liposuction dissolve, which causes fat to just “melt away.”
Weiskopf emphasizes that the biggest problem with liposuction lies in overcorrection.
“You’ve seen celebrities looking hollow-eyed? That’s a sign the process went too far,” Weiskopf says. “Other plastic surgeons advertise treatments that can be performed over the lunch hour. There are a number of new procedures available, but the end result doesn’t necessarily justify the money spent.”
Weiskopf recommends questioning the validity of these new treatments versus traditional procedures.
“Ask yourself if the pictures can possibly be real,” he suggests. “Is it the best possible result? Find people who’ve had similar treatments, to see how they look. Do you want temporary or lasting results? A properly-done face-lift should last about 10 years.”
Another precautionary point Weiskopf brings up is that there’s really no accountability when it comes to what happens within a doctor’s offices. It takes three to five years to establish technique, yet it’s possible to find physicians whose primary practice is not plastic surgery, but who are performing many of these procedures. Pressure from aggressive sales representatives is one of the reasons, backed by promises to heavily promote the physicians who use their products.
“Fillers are something that patients should familiarize themselves with,” Weiskopf says. “We use salt water for breast implants because we believe they are safer and better. Other plastic surgeons prefer gel. Hyaluronic acid filler can be injected under the skin instead of collagen, into the watery layer between the fibrous tissues, but it won’t last. You’re looking at a shot costing $300 to $400 that might last as long as six months but more likely only three months.”
Another concern is the lack of standards for injections such as Botox. Weiskopf warns that some physicians dilute Botox to increase their profit margins. The result is that the injection doesn’t last as long as it normally should. The same is potentially true of Botox and other injectable products sold online by unscrupulous sources.
“Here’s where common sense should prevail,” Weiskopf says. “At this time, there are no ethical standards for promoting these products. There are no watchdog organizations. Practitioners may claim to be board certified or board qualified in a specialty, but no one checks. All they need is a state license in medicine. Hospitals are the exception, in that they do have accreditation committees. The American Society of Plastic Surgeons can also help to offset misuse, but only so long as someone provides them with information.”
The American Association of Ambulatory Anesthesiologists reviews doctors’ offices, as well as several other monitoring agencies with onsite surgery suites, every three years.
“Again, anyone can do anything in an office,” Weiskopf warns. “Know your doctor. Is he or she for real? Certified? Better still, do they have cosmetic and/or plastic surgery fellowships? And remember, experience counts, because it lends foresight and better judgment on critical decisions. Take anything you hear with a grain of salt.”
Reputable plastic surgeons agree that anyone who is considering this surgery should do careful research and talk to family members, friends and co-workers about their experiences. Fortunately for residents of our region, there are responsible and talented professionals available to consult with patients who are considering cosmetic or reconstructive plastic surgery. ❚