Cosmetic Surgery and Procedures

Topic Overview

What are cosmetic surgery and procedures?

Cosmetic surgery and procedures change, restore, or enhance your appearance. There are many reasons for wanting to change or enhance your looks. If you have had burns or other injuries, were born with a birth defect, or want to change parts of your body for other reasons, you may choose to have a cosmetic surgery or procedure.

What are the general types of cosmetic surgery and procedures?

Cosmetic surgery commonly includes:

• Reconstructive surgery. This is typically done to improve a visible scar, skin condition, or malformed body part caused by an injury, a surgery, a disease, or a birth defect. These problems can affect your day-to-day life, including your job, your relationships, and your self-esteem.
• Elective cosmetic surgery. Being unhappy with something about your appearance-such as a large nose, small breasts, wrinkles, or fat around your belly or hips-is a common reason for choosing to have cosmetic surgery. These kinds of things don't bother everyone who has them. But for some people, these things can affect their self-image or confidence. Cosmetic surgery is one way to address them.

Nonsurgical cosmetic procedures include:

• Botox injections.
• Fat deposit removal, either with injectable deoxycholic acid (Kybella) or by freezing fat cells below the surface of the skin with a handheld device (CoolSculpting).
• Filler injections, which include soft tissue fillers.
• Laser hair removal.
• Laser resurfacing to improve acne scars.
• Sclerotherapyinjections for small varicose veins and spider veins.
• Teeth whitening.

This topic focuses on elective cosmetic surgery and procedures rather than reconstructive surgery.

Why are these surgeries and procedures done?

For most of us, our physical appearance affects how we see ourselves and how others see us. The size, shape, and look of our bodies may affect how we feel about ourselves and even how we live our lives.

There is nothing wrong with wanting to change the way you look. Some people do this through diet, exercise, and other lifestyle changes. Others have cosmetic surgery, especially if they are unhappy with a certain part of their body or appearance that can be changed.

What are the risks?

Think carefully about the decision to have cosmetic surgery. Surgery always involves some risk. The risks depend on your health and the type of procedure you have. They can range from slight scarring to infection and even death. Serious problems are rare, but they can occur.

Also, there is no guarantee that you will get the results you want. More than one procedure may be needed. Results are lasting unless you have surgery again. Talk with your doctor about the possible risks and benefits of the surgery.

Who pays for this surgery?

Insurance rarely covers the cost of elective cosmetic surgery and procedures. Unless the surgery is done for medical reasons, you will probably have to pay for it yourself.

These surgeries and procedures can cost a lot. Be sure that you know the total cost of the surgery, including the costs of the procedure itself, any medicines you'll need before or after the procedure, follow-up treatments, office visits, and other expenses.

Are cosmetic surgery and procedures right for you?

Surgery should not take the place of good health habits. There are steps you can take to help you look and feel young and healthy.

• Eat healthy foods.
• Get plenty of exercise.
• Limit how much time you spend in the sun.
• Protect areas of your skin that get the most sun, such as the face, back of the hands, and upper chest or neck.
• Manage stress.
• Don't smoke.
• Avoid drugs and excess alcohol.

Be sure to have realistic expectations about how cosmetic surgery may or may not affect your life. For people who are unhappy with their overall appearance rather than just a certain part of their appearance, cosmetic surgery is probably not the answer. These people are unlikely to be happy with the results of just one cosmetic surgery procedure. They may end up having one procedure after another, which can be harmful and expensive.

Before you choose to have cosmetic surgery, think about your overall health. Remember that all procedures have risks. And having a health condition such as high blood pressure or heart disease may increase the risk.

Talk to your doctor if you are thinking of having a cosmetic procedure or surgery.

Surgery Options

You may have several cosmetic surgery or procedure options to enhance or restore your appearance. Talking with your doctor can help you choose the option that best fits your needs.

Common cosmetic procedures

• Laser resurfacing uses a laser light to heat, damage, or destroy the upper layers of the skin. This can tighten the skin or cause new skin to grow. It is typically used to remove or improve the appearance of wrinkles, brown spots, shallow scars (from acne, surgery, or trauma), and sometimes, the appearance of small veins. Tattoos are removed with surgery or a laser that breaks down the color into fragments. These fragments are removed by your immune system.
• Chemical peel uses a chemical solution to remove the top layers of skin, allowing new skin to grow. It is most often used to remove wrinkles, superficial skin growths, shallow scars, pigment changes in the skin, and other skin problems.
• Dermabrasionuses a fine wire brush or a diamond wheel with rough edges to remove the upper layers of the skin, allowing new skin to grow. It may be used to treat acne scars and wrinkles around the mouth or to treat an enlarged nose (rhinophyma) caused by rosacea (facial inflammation and redness). Microdermabrasion uses a different technique to treat just the top layers of the skin.
• Filler injections are used to smooth wrinkles or pitted scars in the skin. They are also used to make the lips fuller. Fillers can restore volume and structure that is lost due to age or weight loss. When injected under the skin, a filler raises or puffs up that area. This goes away with time.
• Botox injectionsuse a protein that weakens the muscles of the face to reduce wrinkles. The effect is temporary, lasting about 3 to 4 months.
• Sclerotherapy reduces or removes the appearance of small varicose veins and spider veins. In sclerotherapy, a chemical is injected into a vein to damage and scar the inside lining of the vein, which causes the vein to close.
• Laser hair removal and electrolysis permanently remove unwanted hair such as facial hair. In laser hair removal, light treatments are used to heat and destroy hair follicles. This reduces the number of body hairs. In electrolysis, an electric current is applied to the hair root, which heats and destroys the hair follicle. Hair is not able to grow back in this area.
• Medical tattooing uses tattoo ink to change the look of a medical problem. For example, it can be used after breast surgery to create the look of a darker nipple and areola. Medical tattooing can also be used to darken white skin patches (vitiligo) and scarred skin.

Common cosmetic surgeries

• Face-lift (rhytidectomy) removes excess skin and fat and tightens the muscles to smooth the face. Improvement is especially seen along the jawline and in the neck.
• Eyelid surgery (blepharoplasty) removes excess skin, fat, and muscles from the eyelids to correct drooping eyelids and remove bags and puffiness. Surgery may be done on the upper and lower lids.
• "Nose job" (rhinoplasty) reshapes the nose by removing or rearranging its cartilage and bones. Rhinoplasty is done to change the appearance of your nose, improve breathing and nasal function, or achieve a combination of both.
• Breast enlargement (augmentation) places an implant under the breast tissue or the chest muscle to make the breast larger.
• Breast reduction removes excess breast tissue and skin to reshape and lift the breast. Women may seek breast reduction to change their appearance, reduce back pain, and reduce limitations of activities caused by large breasts.
• Liposuction uses suction, ultrasound, or laser to remove stubborn fat that has not gone away with a healthy weight loss diet and exercise. For women, this can be on the outer or inner thighs, neck, upper arms, belly, knees, and hips. For men, this can be on the waist, belly, neck, breasts, or back.
• "Tummy tuck" (abdominoplasty) removes excess skin and fat from the abdominal area and tightens abdominal muscles. When a large weight loss or several pregnancies leave behind extra folds of skin, some people use this surgery for a flatter, smoother stomach. As with liposuction, the purpose of a tummy tuck is to reshape the area rather than to reduce body weight.
• Varicose vein surgery removes large varicose veins. During varicose vein surgery, an incision is made over the varicose vein, and the vein is tied off and either left in place or removed. But newer therapies for vein stripping include foam sclerotherapy and laser or radiofrequency probes that use heat to destroy varicose veins.
• Hair transplant surgery reduces the appearance of bald spots or hair loss by moving hair from one part of the head to another.

Important Considerations

If you are thinking about having cosmetic surgery or a cosmetic procedure, consider the following questions before making a decision.

Why do you want cosmetic surgery?

This is an important question. Take the time to think it through. Cosmetic surgery involves risk and expense. It can permanently change your physical appearance, possibly in a way you didn't expect or that leaves you unhappy. Make sure that cosmetic surgery is what you want. It is not a good idea to change your appearance because someone else wants you to or because you think it will help you get a particular job. If you are content with your appearance, do not let anyone pressure you into having cosmetic surgery. The decision needs to be your own.

If you are unhappy with your appearance, consider other ways to approach your "problem" area before deciding to have cosmetic surgery. For instance, lotions and creams prescribed by your doctor can reduce fine wrinkles. Or makeup may help conceal or de-emphasize wrinkles, scars, and other skin changes. If you are unhappy with the shape of your body, changing your dress and clothing style may help you feel better about how you look. Diet and exercise can often help you achieve the body shape you desire.

If these measures don't work for you, then you may wish to consider cosmetic surgery. Satisfaction levels are generally very high. Your self-image and attitude toward your own body may improve, which can boost your confidence and self-esteem. For some people, this feeling may not last over time.

What are your expectations?

You are more likely to be happy with the results of cosmetic surgery if you have clear, realistic expectations and a clear understanding of why you want to have surgery. First, decide exactly what you would like to change or improve. Then discuss those goals with your doctor, who can tell you whether your goals are realistic and how best to achieve them. Looking at photographs of desirable features may help you decide what you want. Remember, though, that cosmetic surgery is used to enhance your own features and not necessarily to duplicate those of another person whose physical appearance you admire.

Get the facts about what to expect from a certain procedure. Have your doctor show you photographs and explain the full range of possible results. Computer imaging can be helpful, but it can also be misleading. There is no guarantee that the end results will match those created by the computer. With some types of surgery, the results may not appear for several weeks or months after the procedure. It may take several sessions or a combination of procedures to achieve the look you want. And results are not always permanent.

Remember that the effects of time, gravity, aging, and sun exposure continue after cosmetic surgery. Surgery is no substitute for good health habits. Getting proper nutrition and regular exercise, guarding against sun exposure, managing stress, not smoking, and avoiding drugs and excess alcohol can go a long way toward helping you look and feel young and healthy.

Try to have realistic expectations about how cosmetic surgery might affect your life. Changing an aspect of your body that you are not happy with may make you feel more attractive, more satisfied with your appearance, and freer to do things that in the past made you uncomfortable, either emotionally or physically. For some people, the impact may be dramatic. But don't expect cosmetic surgery to solve all your problems. It may change how you look and feel, but it won't change who you are.

Talking with someone who has had cosmetic surgery may raise issues that you had not considered. Ask how the person felt about the results, whether the surgery achieved the results hoped for, and what the total experience was like. Doctors who have experience with cosmetic surgery can also provide perspective on the issues involved.

What can you expect during recovery?

Some types of cosmetic surgery are simple outpatient procedures that allow you to return to your regular activities right away. Others may require you to take days or even weeks off work. Be sure that you understand what your recovery will involve and that you are able to follow your doctor's instructions. Important questions to ask include:

• How long will recovery take? How soon will I be able to return to work or school?
• Will the recovery be painful? What other side effects (bruising, swelling, itching, numbness) will I have, and how long will they last?
• What will I have to do to help my body heal properly? For example, skin resurfacing often requires a very thorough skin care routine during recovery. If you have a face-lift or nose surgery, you may have to keep your head elevated and avoid certain activities for a period of time. Following or not following these instructions can affect the results of the procedure.

What are the risks of cosmetic surgery?

Although many types of cosmetic surgery have very few risks, no procedure is risk-free. The risks vary according to your health and the type of procedure being done. They can range from slight scarring to infection and even death. Serious complications are rare, but they can occur.

It is possible that you may be putting your health and life at unnecessary risk when you have cosmetic surgery. It's important to weigh the risks against the possible benefits.

The other major risks of cosmetic surgery are that it may not produce the changes you want and that it may produce changes that leave you even more unhappy than you were before. Additional treatment may be needed to correct the results of the initial surgery. But the results of cosmetic surgery are often irreversible.

Who pays for cosmetic surgery?

Insurance rarely covers the cost of elective cosmetic surgery done to improve appearance. Reconstructive surgery may be covered if it will improve your physical function or will correct a problem present from birth (congenital) or caused by an accident. But unless cosmetic surgery is done for medical reasons, you will probably have to pay for it yourself.

Examples of cosmetic surgery done for medical reasons that may be covered (or partially covered) by insurance include:

• Treatment of severe scars or disfigurement caused by disease, injury, or birth defects.
• Fixing ears that stick out too far.
• Breast reduction when large breasts cause pain or severely limit a woman's activities.
• Breast reduction of large breasts in men.
• Reshaping of the nose (rhinoplasty) to improve breathing and nasal function.
• Breast reconstruction after surgery to remove breast cancer (mastectomy).

Cosmetic surgery can be quite expensive, especially when you are paying for all of it out of your own pocket. Be sure that you know the total cost of the surgery, including the costs of the procedure itself (such as surgeon fees, anesthesia fees, and operating facility fees), any medicine before or after the procedure, follow-up treatments, office visits, and other expenses.

Also be prepared to cover costs resulting from complications during or after surgery or the need for "touch-up" surgery. Insurance may not cover treatment for complications that arise from cosmetic surgery. Some procedures, including skin treatments, liposuction, and breast enlargement, may have to be repeated as time goes by, to maintain the results. You will have to pay for these repeated treatments just as you paid for the initial treatment.

Choosing a Surgeon and Facility

Finding a cosmetic surgeon that you have confidence in and are comfortable talking to is extremely important when you are considering cosmetic surgery or procedures. You and your doctor can work together to build a treatment plan that both meets your needs and is realistic.

You may want to schedule a consultation with a cosmetic surgeon. Many cosmetic surgeons offer free or low-cost consultations. Sometimes a consultation fee is applied to the cost of the surgery.

No other single thing may influence the results of cosmetic surgery as strongly as the doctor's level of experience. Don't be afraid to ask about the doctor's experience with the procedure you are considering. Request before-and-after photographs of other people who have had the procedure done. And ask to see the worst results as well as the typical and best results.

Doctors with special training in cosmetic surgery should be board-certified by the American Board of Plastic Surgery or the American Academy of Facial Plastic and Reconstructive Surgery.

Take your time finding a cosmetic surgeon that you like and trust. Ask your doctor for recommendations. And contact the American Society of Plastic Surgeons, the American Academy of Facial Plastic and Reconstructive Surgery, or the American Society for Aesthetic Plastic Surgery for a list of qualified surgeons in your area.

You will have a greater chance of being happy with the results of cosmetic surgery if you find a cosmetic surgeon who listens to you and understands what you want to achieve. People differ in what they consider an "ideal" face, nose, breast, or body type. Your and your doctor's vision of what is ideal may not be the same. Make sure that your doctor understands what you want. Also remember that cosmetic surgery is done to enhance your own appearance and not necessarily to duplicate that of someone whose physical appearance you admire.

It is important to understand and accept what can and cannot be achieved with cosmetic surgery, based on your skin or body type, age, medical history, the surgeon's experience, the limits of technology, and other things. A good cosmetic surgeon can help you understand how these things affect your cosmetic surgery options.

Any licensed medical doctor can legally perform cosmetic surgery, but the levels of training and experience in cosmetic surgery vary widely. For your own safety, avoid doctors who are not board-certified, and look for a cosmetic surgeon with a lot of experience. Doctors who most commonly do cosmetic surgery and procedures include:

• Plastic and reconstructive surgeons. These doctors are board-certified specialists in cosmetic surgery and reconstructive surgery and have multiple years of training in these fields. All members of the American Society of Plastic Surgeons are board-certified by the American Board of Plastic Surgery.
• Otolaryngologists, also called ear, nose, and throat (ENT) specialists. Many of these doctors have additional training in cosmetic surgery of the head and neck and may belong to the American Academy of Facial Plastic and Reconstructive Surgery.

You may also check the credentials of any outpatient surgery center that you are considering, to make sure it is safe and reliable. Look for clinics that have a well-established track record for good results and high-quality service, and avoid those that do not. The facility should be licensed by the state in which it is located and accredited by a nationally recognized accrediting organization. To check a facility's accreditation status, contact the American Association for Accreditation of Ambulatory Plastic Surgery Facilities (www.aaaasf.org), the Accreditation Association for Ambulatory Health Care (www.aaahc.org), or the Joint Commission on Accreditation of Healthcare Organizations (www.jointcommission.org).

Other sources of helpful information include consumer health groups, people who have had cosmetic surgery, other doctors, books and articles, and the Internet. But do not put too much trust in before-and-after photos you may find on the Internet. Some may have been altered by computer or are likely to represent an extremely positive result, not necessarily a typical result. In either case, before-and-after photos on the Internet may give you a false impression of the results you can expect.

Cosmetic surgery is not an emergency procedure, so there is no reason to rush into it. Do not be pressured into making a quick decision. Get as much information as you need to feel comfortable about your decision. Don't be afraid to get a second and even a third opinion, especially if you are not completely comfortable with your first doctor visit.