Plastic Surgery: What to Know Before You Go

Whether it’s a tummy tuck or a facial touch-up, plastic surgery still is a medical operation. Learn from the experts about finding a reputable plastic surgeon and what questions to ask.

Time, trauma and genetics: these are the reasons people seek help from plastic surgeons. They want to look their best and feel good about themselves.
Dr. Sarah Hagarty, 698 Featherstone Road, Rockford, a board-certified plastic surgeon at OSF Saint Anthony Medical Center, says the majority of her patients have fairly realistic expectations about seeking help with fine lines, pigment changes of the skin, sagging jaw lines, or drooping skin around the eyelids, cheeks, and neck.
“The number of patients who have psychological issues are relatively few,” Hagarty explains. “The cosmetic aspect of plastic surgery can sometimes get a bad reputation from a small number of extreme cases, but the truth is that most patients are reasonable about what they want.”
Hagarty’s first task with a patient is to assess whether the desired improvements are feasible. Sometimes a patient is fixated on a certain procedure or treatment, when something else is what’s needed.
“A reputable plastic surgeon doesn’t simply dictate what a patient needs,” says Hagarty. “It’s better to find a balance between what the patient is looking to improve on and the best and safest way to achieve that in a given individual.”
Lines and wrinkles in the face are the most common complaint patients bring to her; they don’t expect absolute beauty or youth, but they want to improve upon their aged, tired look, says Hagarty. Because they have standing wrinkles at the mouth or eyes, other people may have commented that they look sad or angry. What her patients want is a more rested, healthy look.
“Often a first change, after laugh lines, is a drooping brow. The natural response is to pluck eyebrows higher,” Hagarty says. “In early stages, Botox can be used to shape the brows unless the skin is too stretched. After that, surgery may be the next logical step. What needs to be done depends not only on the quality, but also the quantity of skin, as well as the underlying supportive structures which hold the peri-orbital fat in place.”
Besides normal aging, allergies and frequent puffy eyes can worsen bags and dark circles, stretching tissue and making areas under and around the eye bulge. “We address the underlying problems and fix them, by tightening skin and support structures or by removing or adding a little fat, because each patient’s facial structure and aging process is unique,” Hagarty adds.
Rhinoplasty, also called a “nose job,” is another frequently requested procedure. Hagarty often corrects noses that are disproportionate to the patient’s face, or those with large dorsal humps or bulky bulbous or drooping tips. She also corrects noses that are misshapen or asymmetrical because of injury. Noses are highly conspicuous because they’re front and center on the face. She adds, however, that the traditional Caucasian nose is no longer the standard.
“The modern cultural perception of a beautiful nose, including perceptions held by plastic surgeons, has thankfully evolved to a more global appreciation, from the stylized nose of narrow bridge and small upturned tip,” Hagarty explains. “Beauty is seen the world over and has more to do with the overall balance of an individual person’s face and bone structure than a particular shape for that one given feature. The goal is harmony of the entire face, aiming for a look that respects a person’s cultural heritage and yet optimizes that individual patient’s natural features.”
When it comes to facelifts, there are many options, from a less-invasive, short scar “mini facelift,” which is helpful for early changes like mild drooping of the jawline or prominent nasolabial folds, to a full face and neck lift, or even a forehead lift, to address all the components of the face, together, and counter more advanced signs of aging.
“Gravity, soft tissue loss and the constant pull of certain muscles of facial expression are the forces to be reversed,” Hagarty says. “A patient’s bone structure and genetic makeup also come into play. That being said, sometimes a simple mini-facelift is all it takes to contour and firm the jawline and a bit of the neck in a fresh, pleasing manner.”
“Generally, we pull the skin up and back, both in front of and behind the ears, anchoring to the underlying fascia, with some cutting of the skin, depending on the patient’s bone structure and musculature,” Hagarty explains. “Occasionally, volume is added with fillers or fat grafting. Sometimes, muscle bands in the neck need to be released or tightened while reducing the amount of skin on the neck and under the chin. My patients often say the pain is not that intense, but they may experience swelling for up to two weeks, and bruising up to two or three weeks.”

Body Sculpting

Beyond the face, body sculpting can be accomplished through one of two types of surgical procedures: suction assisted lipectomy (liposuction) or excisional techniques.
Dr. Landon Pryor, board-certified plastic surgeon and president of Transformations Plastic Surgery, 1639 N. Alpine Road, Rockford, says that determining the best approach to satisfy each patient’s needs and expectations requires a careful analysis and individualized treatment.
“Liposuction is a commonly requested procedure, and can often yield a good outcome, if done safely and for the right patient,” Pryor explains. “Just because a friend or family member had a good result with liposuction doesn’t necessarily make it the right choice for anyone seeking some type of body contouring.”
Since anatomic issues are always specific to each patient, Pryor emphasizes the importance of evaluating the quality and quantity of excess skin and subcutaneous fat.
“If indicated, liposuction can typically suction up to five liters of fat in one procedure,” Pryor explains. “The outcome of this technique is dependent upon the ability of the overlying skin to appropriately contract following removal of the fat. If the skin is of poor quality or in significant excess, liposuction can make the problem even worse. Generally, younger patients with firm skin of good quality and more localized areas of fat deposition will make the best candidates for this procedure.”
Excisional techniques are performed in body contouring surgeries that are designed to remove both excess skin and fat in specific areas of the body. These techniques are commonly used in abdominoplasty (tummy tuck) and brachioplasty (arm lift). These patients, in contrast to patients who are better candidates for suction assisted lipectomy alone, more commonly come to Pryor with more significant skin laxity, sometimes following pregnancy or weight loss.
“In the most extreme cases of massive weight loss, entire anatomic units can be surgically addressed together to more comprehensively address the body in three dimensions,” Pryor says. “These surgeries, commonly referred to as ‘body lifts,’ can be longer, with potentially more risks involved, and should be carefully discussed and planned to minimize adverse outcomes.”
Pryor notes that both liposuction and excisional surgeries can be applied separately or, when appropriate, safely combined to achieve synergistic and powerful results. However, he also cautions that doing too much at one time can be hazardous. Using good clinical judgement that’s appropriate for each patient’s situation, as well as adhering to specific guidelines put forth by the American Society of Plastic Surgeons (ASPS), is of paramount importance, especially in longer and more involved surgeries.
“This underscores the importance of seeking out the most-qualified surgeons that have been certified by the American Board of Plastic Surgery,” Pryor says. “Additionally, plastic surgeons with extensive experience in performing cosmetic plastic surgery are eligible for inclusion into The American Society for Aesthetic Plastic Surgery (ASAPS), which is known as the ‘Mark of Distinction’ in cosmetic plastic surgery.’”
He advises that anyone interested in pursuing any type of plastic surgery should always be aware of their prospective doctor’s training and credentials.

Credentials Matter

Every reputable plastic surgeon is concerned about the training and experience levels of noncertified technicians, and with good reason. Dr. Jerome S. Weiskopf, 6533 Lexus Dr., Rockford, says that, unfortunately, techniques such as liposuction are being offered by questionable providers all too often.
“You need to understand that lasers and other cosmetic surgery equipment are simply tools, and that most of today’s plastic surgery innovations are product-driven,” Weiskopf says. “I would caution patients about buying into facelifts and other procedures advertised on television and websites. Others charge $3,500 to $4,000 just to tighten facial skin. Remember that old adage, ‘if it sounds too good to be true, it probably isn’t true.’”
Weiskopf explains that some procedures are tenuous at best. As an example, he cites the “lunch facelift,” which is actually more of a laser facial abrasion procedure. It leaves the patient’s skin a little red, while producing, at best, very subtle results. Patients may be paying for a promise that doesn’t materialize.
No one wants to be scammed.
“When patients ask about full facelifts, I explain it’s more of a neck lift, in which we pull up the skin, tightening the lower face and getting rid of unsightly jowls,” Weiskopf says. “A properly done full facelift should last for 12 to 15 years, depending on the patient’s age and skin quality, and should cost around $8,000.”
Laser procedures do have their place, he adds. They’re useful for facial resurfacing, as well as removing blemishes and wrinkles, particularly around the delicate mouth skin.
Asked about facial fillers, Weiskopf says, “Botox is still very popular as a temporary fix, and can cost from $500 to $1,000 per treatment. Occasionally, a patient will retain the effects of Botox much longer than average, and every patient hopes he or she is the one whose treatment will last.”
Collagen is no longer used as a filler because of an adverse reaction suffered by some patients. Safer fillers have been developed, says Weiskopf, but the downside is that they don’t last as long. Body fat can be used for a filler, as well, but it needs to be taken from somewhere else on the body.
“We can suction fat from a patient’s abdomen or buttocks and inject it into the face to reduce deep wrinkles,” Weiskopf explains. “But, it doesn’t change the type of fat at all. If a patient gains weight after the procedure, and tends to store it in the abdomen or buttocks, then it will also be stored in the fat that was transferred to his or her face. And what you get then is lumps and bulges which have to be suctioned out.”
While equipment, techniques and procedures can vary widely, one facet of plastic surgery remains the same. The competence and integrity of the medical professionals who are doing the work is the most important element. Every patient’s face, body and future are in their hands.