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Thursday, January 19, 2006

Denver Rocky Mountain News



Nothing hurts more than a broken nose - not even having a baby.

This from someone who has had two unmedicated births and three unmedicated broken noses.

The first time, my nose and I smacked into a concrete floor after a fall from a cabinet I mistakenly thought was anchored to the wall. The second time, I ran nose-first into a plate-glass window that I mistook for a door. The third time, I jumped from a runaway horse I thought I could control, despite the fact that it had no saddle or bridle. My choice: either leap onto my nose or be decapitated when Zippy finally blasted into his stall.

By the time I turned 13, my nose made me look as if I'd had a long but unfortunate boxing career, and it no longer functioned as an airway. Finally getting my septum undeviated was like a revelation - I can breathe! It's a miracle!

Praise the Lord for 19th century German surgeons Carl Von Graefe, father of modern facial reconstruction - who coined the term - and Jacques Joseph, father of the modern nose job.

Last year, Americans spent $8.4 billion for 9.2 million procedures to enlarge their assets, reshape their schnozzes, tuck their tums, unload their saddlebags and fill in their wrinkles, according to the American Society of Plastic Surgeons.

Liposuction is the top surgical seller, followed by noses, breasts, eyelids and face-lifts. So-called "lunchtime" procedures - Botox, cellulite treatments and the like - have exploded in popularity, ASPS spokeswoman LaSandra Cooper says.

The number of Botox treatments, for example, has increased 280 percent in the past five years, with most done in people younger than 50.

While such procedures are strictly cosmetic, some surgeries qualify as both cosmetic and reconstructive, the two subsets of .

Consider the mangled nose: It's not normal-looking (or in my case, functioning) because it's been broken three times. So fixing it - bringing it back to the way it's supposed to be - qualifies as reconstructive. On the other hand, making it look better is also cosmetic.

Breasts can be the same way. A woman might have lost one or both to cancer, and reconstruction can give back what disease took away.

Or there may be absolutely nothing wrong with a woman's breasts: They're the ones she was born with. But maybe they haven't gotten much bigger since then.

From a surgical standpoint, breasts are much simpler to improve than facial features.

"I can make a far more beautiful breast starting with an average or sub-average breast," says Denver plastic surgeon John Grossman. "A face is far more complex."

So forget looking like Catherine Zeta-Jones. But leafing through a Victoria's Secret catalog or a Sports Illustrated swimsuit issue for the kind of cleavage you crave isn't necessarily far-fetched. It's a safe bet much of what you're looking at has been surgically enhanced, because there's no way a 5-foot-10-inch woman who weighs 110 pounds has a 36-D bust. Breasts, after all, are mostly fatty tissue. On the other hand, supermodel Tyra Banks recently went to the extreme of having a doctor feel her up on national television to prove she's the real deal. But then, she's no size 2, either.

Who's getting , besides everybody on television? If you guessed wealthy middle-age white women, you're only partly right.

Yes, they're mostly white, and they're mostly women, but a study found that of 644 people considering having in the next two years, 70 percent have household incomes of $60,000 or less, and nearly 30 percent make less than $30,000. Nearly 65 percent are younger than 50, and 26 percent are from 18 to 29.

I was 17 at the time of my surgery. I remember a conversation with my father where I pointed out that my nose didn't work and it didn't look so hot, either.

"I like your nose," he said. "It looks just like mine."

"A 17-year-old girl should not have the nose of a 57-year-old man," I said.

Like me, most of the people in the study aren't trying to make themselves look like someone else. They're simply trying to feel better about looking in the mirror or to stop mouth-breathing. Most think will make them physically healthier and more self-confident, and men in particular expect surgery with benefits. Yes, those benefits.

But beware of unrealistic expectations: All surgery has risks and involves pain and weeks of recovery. And at the end of the day, you're still you.

"Cosmetic surgery isn't going to make you more talented than you are," Grossman says. "It's not going to repair a failing or broken marriage or make you qualified for a job for which you're not qualified. And it's not a transformation from a troll that crawled out from under a bridge into a Prince Charming."

Where you can go with depends a lot on where you are to begin with. Grossman mentions a patient who wanted her face-lift to make her look as good as Dolly Parton. That's not going to happen, he says, because there are just some people who are naturally more beautiful than the rest of us.

"I can do a fabulous job with you and what you have to work with," Grossman says. "But you're not just a lump of clay. There are limitations."

Unreal reality TV has skewed the public perception of what is. A survey of 220 adults found that many thought cosmetic surgery was less painful, less risky and easier to do and undo than procedures called "" or "reconstructive surgery." The study, which appeared in the Archives of Facial and Plastic Surgery, found that people also thought cosmetic surgeons require less training than those who do "plastic" surgery.

Some of them have less training - there are doctors who call themselves cosmetic surgeons who have none whatsoever, Grossman says. Look for a surgeon who has been certified by the American Board of Plastic Surgery, and look for someone who regularly does the procedure you want.

He recommends examining pictures of results and talking to someone who has had the same operation - someone besides the doctor's employees.

And don't shop price - going to Indonesia to have with a doctor of unknown skill is nuts. If saving money is the object, skip the surgery and try therapy.

"In some ways, those (makeover) shows are good for because they showcase just how much we can do," Grossman says. "But they're also very bad in that they deal with pitiable people whose self-esteem is in the toilet. They should be seeing a psychiatrist, not a plastic surgeon."


Top 5 cosmetic procedures in 2004

* Liposuction 324,891

* Rhinoplasty (nose) 305,475

* Breast augmentation 264,041

* Eyelids 233,334

* Face-lift 114,279

Source: American Society Of Plastic Surgeons


Handling your case with care

Steps to take if you're considering

Find a surgeon

Ask your physician, get referrals from friends or family, or call hospitals and ask who's on staff. The American Society of Plastic Surgeons has a referral service: www.plasicsurgery.orgor call 1-888-4-PLASTIC (1-888-475-2784).

Check your doctor's credentials

What type of training has he had? Be sure the surgeon completed an accredited residency program in . The American Medical Association lists what type of training a physician has had and where it took place. A physician performing also should be certified by the American Board of Plastic Surgery, the only board recognized by the American Board of Medical Specialties.

Schedule a consultation

This is a chance to discuss your goals and to get advice on the best procedure to achieve your desired results. Your plastic surgeon should:

* Answer all your questions thoroughly and clearly.

* Offer alternatives, where appropriate, without pressuring you to consider unneeded or additional procedures.

* Welcome questions about your procedure and his or her professional qualifications, experience, costs and payment policies.

* Make clear the risks of surgery and possible outcomes.

* Give you information about the procedure you want.

* Leave the final decision to you.

Your plastic surgeon should also ask lots of questions, including:

* Are you certified by the American Board of Plastic Surgery?

* Do you have hospital privileges to perform this procedure? If so, at which hospitals?

* How many procedures of this type have you performed?

* Am I a good candidate for this procedure? What will be expected of me to get optimal results?

* Where and how will you perform my procedure?

* Is the surgical facility accredited?

* What are the risks involved with my procedure?

* How long a recovery period can I expect, and what kind of help will I need during my recovery?

* Will I need to take time off work? If so, how long?

* How much will my procedure cost? Are financing options


* How are complications handled?

Source: American Society Of Plastic Surgeons


Most common nips and tucks

Here are descriptions of the top five cosmetic surgical procedures performed last year, in order. All the operations take at least two hours and usually don't require a hospital stay. The average cost listed is only the surgeon's fee and doesn't cover anesthesia or hospitalization:

Liposuction (suction-assisted lipectomy)

Improve body shape by removing exercise-resistant fat deposits with a tube and vacuum device. Common locations include chin, cheeks, neck, upper arms, above breasts, abdomen, buttocks, hips, thighs, knees.

* Side effects: temporary bruising, swelling, numbness, soreness, burning sensation

* Risks: asymmetry, rippling or bagginess of skin, pigmentation changes, skin injury, fluid retention, excessive fluid loss leading to shock, infection

* Recovery: Back to work: 1 to 2 weeks. More strenuous activity: 2 to 4 weeks. Full recovery from swelling and bruising: 1 to 6 months or more

* Results: Permanent, with sensible diet and exercise

* Average cost: $2,200

Nose surgery (rhinoplasty)

Reshape nose by reducing or increasing size, removing hump, changing shape of tip or bridge, narrowing span of nostrils, or changing angle between nose and upper lip. May also relieve some breathing problems, so may be covered by insurance.

* Side effects: temporary swelling, bruising around eyes and nose, headaches; some bleeding and stiffness

* Risks: infection; bursting of small blood vessels, resulting in tiny, permanent red spots; incomplete improvement, requiring additional surgery

* Recovery: Back to work: 1 to 2 weeks. More strenuous activities: 2 to 3 weeks.

Final appearance: 1 year or more

Results: permanent.

Average cost: $3,300

Breast enlargement (augmentation mammaplasty)

Enhance the size of breasts using inflatable implants filled with saline.

* Procedure: 1 to 2 hours, local anesthesia with sedation, or general anesthesia, usually outpatient.

* Side effects: temporary soreness, swelling, change in nipple sensation, bruising

* Risks: Lack of implant permanence - surgical removal or replacement of the implants may be required to treat problems such as scar tissue or deflation. Mammography requires a special technique.

* Recovery: Back to work: a few days. Physical contact with breasts: 3 to 4 weeks. Fading of scars: several months to a year or more.

* Results: Variable. Implants may require removal or replacement.

* Average cost: $3,400

Eyelid surgery (blepharoplasty)

Correct drooping upper eyelids and puffy bags below the eyes by removing excess fat, skin and muscle. Upper-eyelid surgery may be covered by insurance if used to correct visual problems.

* Side effects: temporary discomfort, tightness of lids, swelling, bruising, dryness, burning, itching; excessive tearing; sensitivity to light for first few weeks.

* Risks: infection, bleeding, swelling at the corners of the eyelids, dry eyes, temporary blurred or double vision, formation of whiteheads, slight asymmetry in healing or scarring

* Recovery: Reading: 2 or 3 days. Back to work: 7 to 10 days. Contact lenses: two weeks or more. Strenuous activities, alcohol: about 3 weeks. Bruising and swelling gone: several weeks.

* Results: Several years. Sometimes permanent.

* Average cost: $2,500

Face-lift (rhytidectomy)

Improves sagging facial skin, jowls and loose neck skin by removing excess fat, tightening muscles, re-draping skin. Most often done on men and women over 40.

* Side effects: temporary bruising, swelling, numbness and tenderness of skin; tight feeling; dry skin. For men, permanent need to shave behind ears, where beard-growing skin is repositioned.

* Risks: injury to the nerves that control facial muscles or feeling (usually temporary but may be permanent), infection, bleeding, poor healing, excessive scarring, asymmetry or change in hairline.

* Recovery: Back to work: 10 to 14 days. More strenuous activity: 2 weeks or more. Bruising: 2 to 3 weeks. Must limit exposure to sun for several months.

* Results: usually 5 to 10 years

* Average cost: $4,800

Techniques on the horizon

* Focused ultrasound: A noninvasive body-sculpting technique, it can give patients the benefits of minimal to mild liposuction without the downtime. Three studies have shown a single treatment to significantly reduce the circumference of the targeted area.

* Suture suspension techniques: The use of barbed or trumpet sutures might offer a face-lift alternative that gives fast results and recovery.

For more information or to find a physician, go to " class="emaillink" target="window">

Source: American Society Of Plastic Surgeons

Copyright © 2005, Denver Publishing Co.