Cosmetic Surgery

Cosmetic Surgery is a subspecialty of medicine and surgery that uniquely restricts itself to the enhancement of appearance through surgical and medical techniques. It is specifically concerned with maintaining normal appearance, restoring it, or enhancing it beyond the average level toward some aesthetic ideal. Cosmetic Surgery is a multi-disciplinary and comprehensive approach directed to all areas of the head, neck and body.

Special skill and knowledge are essential and specialists in Cosmetic Surgery are competent in the anatomy, physiology, pathology and basic sciences. The educational profile of this specialty is unique in that it begins with a fully trained and certified physician. Through continued post-residency education, training and experience, cosmetic surgery is taught and learned across traditional disciplinary boundaries. The subspecialty fully incorporates the participation and knowledge from all contributing disciplines to attain a high level of skill and understanding. Contributing disciplines include dermatology, facial plastic surgery, general surgery, plastic surgery, otolaryngology, oculoplastic surgery, oral-maxillofacial surgery and others.

The Cosmetic Surgeon offers specialized expertise in patient education and counseling, procedural skills, and the early recognition and treatment of complications. As a specialty, Cosmetic Surgeons have enhanced the knowledge and training of fellow physicians and directly benefited society through educational publications, scientific journals and in the development of safe and innovative techniques.
Competency in Cosmetic Surgery implies a combination of knowledge, surgical judgment, technical expertise and ethics in order to achieve the goal of providing aesthetic improvement.

Special skill and knowledge are essential and specialists in Cosmetic Surgery are competent in the anatomy, physiology, pathology and basic sciences. The educational profile of this specialty is unique in that it begins with a fully trained and certified physician. Through continued post-residency education, training and experience, cosmetic surgery is taught and learned across traditional disciplinary boundaries. The subspecialty fully incorporates the participation and knowledge from all contributing disciplines to attain a high level of skill and understanding. Contributing disciplines include dermatology, facial plastic surgery, general surgery, plastic surgery, otolaryngology, oculoplastic surgery, oral-maxillofacial surgery and others.

The Cosmetic Surgeon offers specialized expertise in patient education and counseling, procedural skills, and the early recognition and treatment of complications. As a specialty, Cosmetic Surgeons have enhanced the knowledge and training of fellow physicians and directly benefited society through educational publications, scientific journals and in the development of safe and innovative techniques.
Competency in Cosmetic Surgery implies a combination of knowledge, surgical judgment, technical expertise and ethics in order to achieve the goal of providing aesthetic improvement.

Common reconstructive surgeries are: breast reconstruction for women who have had a mastectomy, cleft lip and palate surgery, contracture surgery for burn survivors, and closing skin and mucosa defects after removal of tumors in the head and neck region. Sex reassignment surgery for transsexual people is another example of reconstructive surgery.
Plastic surgeons have developed the use of microsurgery to transfer tissue for coverage of a defect when no local tissue is available. Tissue “flaps” comprised of skin, muscle, bone, fat or a combination, may be removed from the body, moved to another site on the body and reconnected to a blood supply by suturing arteries and veins as small as 1-2 mm in diameter.

There is a definite gray area between reconstructive and cosmetic surgery. Many of the techniques of cosmetic surgery are utilized in reconstructive surgery to improve cosmesis.

History of Plastic Surgery
The history of plastic surgery began more than 4,000 years ago. Although reconstructive surgery was used in India in 800 BC, the history of plastic surgery moved very slowly for thousands of years, especially in European medicine.
In the late 19th century the American medical community embraced reconstructive surgery and the history of plastic surgery in the United States began. The first major American surgeon to make his mark in the history of plastic surgery was Dr. John Peter Mettauer, who performed the first cleft palate operation in the North American history of plastic surgery in 1827 with instruments he designed himself.
War played a huge role in the history of plastic surgery. World War I presented physicians with scores of severe facial wounds and burns, changing the history of plastic surgery. Modern weapons caused types and severity of injuries that were unprecedented in the history of plastic surgery. Some of the greatest medical talent devoted themselves fully both to exploring the history of plastic surgery and creating new techniques to treat men maimed by the war. Aesthetic surgery took its place in the history of plastic surgery at around this time, as surgeons fully realized the influence of appearances on individual success.
The history of plastic surgery in America owes much to the American Society of Plastic and Reconstructive Surgeons (ASPRS). In the history of plastic surgery, no such organization for American plastic surgeons had existed prior to 1931. Important steps in American history of plastic surgery took place due to the work of this institution, such as recognition of the progress and history of plastic surgery by the American Board of Surgeons. ASPRS members created the first qualifying exam in the history of plastic surgery in the US, and a number of other organizations for promoting the future and history of plastic surgery sprang up in the years that followed.

The modern, and more well-known, history of plastic surgery begins in the 1960s and 70s. Plastic surgeons were contributing to the history of plastic surgery in a number of areas, including a Surgeon General, and a Nobel Prize winner. The past few decades in the history of plastic surgery have brought enormous advances in treatment and awareness among the public. As the history of plastic surgery continues to be written, the ways to improve form and function will continue to expand.
Reasons encouraging Plastic Surgery

1-Psychological Surgery
A surgeon’s first impressions within an evaluation of a patient often prove most useful for gauging the suitability of a surgical procedure. The patient’s general appearance, demeanor, and behavior can also serve as indicators of a concealed psychic disturbance. Diagnostic acumen requires an awareness of subtle signs suggestive of potential problems, and the surgeon must practice intuitive observation of the patient at all times. Is the patient’s dress provocative and alluring? Does the patient retreat from physical contact or actively avoid eye contact? How is the patient’s affect and mood? Is the voice monotone or easily excitable? Surgeons can expect their patients to be nervous and self-conscious during consultation; however, such patients may need additional observance because nervousness may be an indicator of some emotional disturbance. Anxiety is common at the first meeting and can hamper retention, expression, and comprehension of the goals, benefits, and complications of surgery. Consider a follow-up visit for any patient with suspected emotional instability.
Many different personality traits and behavioral clues exist. The categorizing of personalities does not imply an abnormality. In fact, the traits associated with certain personality types can be useful and adaptive because they allow the patients to tolerate anxiety, solve problems, and cope with a variety of life’s stresses.

However, patients with some personality types are not well suited for cosmetic surgery; these personality types are categorized according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) as personality disorders. They include schizoid, paranoid, histrionic, and depressive personality disorders. Patients with these personality disorders deserve closer attention because the personality disorders are often associated with psychiatric complications, and the patients are unfit for cosmetic surgery.
Schizoid personality disorder
Individuals with schizoid personality disorder are described as being socially withdrawn, introverted, eccentric, and uncomfortable with others. Such patients often express vague reasons for wanting aesthetic surgery and are unable to supply precise goals for the procedure even after further questioning. The patient may request surgery because “it would be better to look that way.” Characteristically, these patients avoid eye contact, show little emotion, and have difficulty relaxing during consultation with the physician. They make few, if any, spontaneous comments, and they answer questions without elaboration.
Paranoid personality disorder
Paranoia refers to a pervasive and unwarranted skepticism of others. The individual with paranoid personality disorder is most commonly a young, unmarried male. The patient is often a loner and hypersensitive. Individuals with paranoid personality disorder are likely to have an unstable work history, to present themselves as innocent victims of unfairness, and to place blame on others. Patients with this disorder can appear tense, guarded, and secretive.

Histrionic personality disorder
Individuals with histrionic personality disorder are often excessively emotional and seek constant attention. They are colorful with labile and shallow emotional responses, from laughing easily to bursting into tears. These patients can use their fantastic displays of emotion and appearance to control others. They have an intense need for attention, and they seek it through their external appearance, about which they are excessively worried. During an interview, patients with histrionic personality disorder constantly seek reassurance, approval, or praise. They often have a style of speech that is highly impressionistic. For example, when the patient is asked to describe his or her mother, the answer may not be more specific than, “She was a beautiful person.”
Depressive personality disorder
Patients who have depressive personality disorder do not necessarily desire cosmetic surgery; rather, they may be prone to seek it believing that an enhanced physical appearance will improve their feelings about themselves.
Body dysmorphic disorder
Unlike different personality traits and normal concerns about one’s appearance, the preoccupation with appearance in body dysmorphic disorder (BDD) is excessively time-consuming and associated with significant distress or impairment in social, occupational, or other areas of functioning. BDD is a psychiatric illness. The defect in appearance is either imagined or slight. The preoccupation is also not better accounted for by another mental disorder.
Proper selection of patients for aesthetic surgery must start with an effective assessment of the psychology, of which motivation is perhaps the most important part. Patients’ motives for seeking aesthetic surgery are as numerous as the patients themselves, and not every reason or person desiring the surgery is suitable. Motivation may stem from various sources. Because aesthetic surgeons typically do not receive formal training in psychiatry, they often have difficulty in correctly diagnosing the true motives. Consequently, aesthetic surgeons attempting to distinguish patients as emotionally appropriate or inappropriate often rely on their own experience, teachings of their mentor, or simply a gestalt approach.

Not all internal or external motivations are appropriate for surgery. Several examples of external motivation deserve a closer examination. The need to please others (eg, husband, relatives, lover, strangers) often arises from the false belief that a change in outward appearance will produce results such as saving a marriage or improving a relationship. Of course, this notion is rarely true and may indicate something more serious with the patient. Furthermore, patients who are pressured into cosmetic surgery may be passive about the procedure and are not suitable candidates. The appropriate patient is active in deciding to pursue surgery and is not influenced by others.
The intensity of the motivation has been demonstrated to be negatively correlated with postoperative pain and positively associated with a shorter postoperative course and satisfaction.
Seeking cosmetic surgery as a way to advance one’s career often results in more disappointment than satisfaction after surgery. Despite the generally held notion that more attractive persons are more successful, using plastic surgery as the means to such an end is often ill-advised. Conversely, if the patient is aware that successful surgery does not ensure career advancement, the patient may use the enhanced appearance more effectively.
Patients citing internal motives for aesthetic surgery are generally considered good candidates. Internal motivations may be described as long-standing feelings about deficiencies in physical appearance and a strong commitment to physical change.

However, the definition of a facial deficiency differs widely among patients and needs an individualized elucidation. A condition that appears as a slight consequence to the surgeon may not appear as such to the patient. The line separating a genuine deficiency from a perceived deficiency is often indefinite. No proportional relationship exists between the disfigurement and the mental attitude it engenders in the patient.
Candidates with the appropriate internal motivation temporarily seem to lack adaptation to a particular situation. The psychological state reflects a definite physical defect, and surgical restoration relieves the anxiety. This is very different from a patient for whom the disfigurement is the only focus. For such a patient, once one part of the face is fixed, the patient quickly finds another symptom through which to channel the neurosis.

A. Preauthorization is not required for plastic surgery benefits. Benefits may be provided for cosmetic, reconstructive, and/or plastic surgery, including otherwise covered services and supplies under the following circumstances:
1. Correction of a congenital anomaly, i.e., a condition that exists from birth and that is a significant deviation or departure from the norm and is other than a common racial or ethnic feature (examples of such conditions include, cleft lip/cleft palate, birthmarks, webbed fingers or webbed toes, or surgery to correct pectus excavatum is covered as correction of a congenital anomaly when the defect is more than a minor anatomical anomaly).
2. Restoration of body form (including revision of scars) following an accidental injury.
3. Revision of disfiguring and extensive scars resulting from hypertrophic contractures, keloids, and neoplastic surgery. Note: Keloid revision requires medical review of medical documentation that includes history, size, location, and symptoms.
4. Panniculectomy performed in conjunction with other abdominal or pelvic surgery is covered when medical review determines that the procedure significantly contributes to the safe and effective correction or improvement of bodily function. (See Exclusions).
5. Penile implants and testicular prostheses for conditions resulting from organic origins or organic impotency.
6. Liposuction when used as a substitute for the scalpel is covered when medically necessary, appropriate, and the standard of care.
7. Augmentation mammoplasty, reduction mammoplasty, and mastopexy surgery performed on one breast for contra lateral symmetry to bring it into symmetry with a post-mastectomy reconstructed breast

Risk Related to the Surgery
Skin Death or Necrosis: usually follows an infection or hematoma and is much more likely among smokers. The skin is excised (surgically removed) and this may affect the cosmetic outcome.

Asymmetry: moderate or severe asymmetries may require a second surgery. Mild asymmetry is normal.

Slow Healing: due to age, skin type, failure to follow doctor’s advice or factors beyond anyone’s control.

Numbness/Tingling: often temporary, sometimes permanent loss of sensation. This results from injury to sensory or motor nerves.

Irregularities, dimples, puckers, and divots: can be due to surgeon error, healing irregularities or body make-up.

Seroma: fluid can collect under the skin and can occur after breast augmentation, liposuction or a tummy tuck.

What You Should Know About the Safety of Outpatient Plastic Surgery

Plastic surgery procedures performed in accredited surgical facilities by board-certified plastic surgeons have an excellent safety record. A 1997 survey1 based on more than 400,000 operations performed in accredited facilities found that:
• The rate of serious complications was less than half of 1 percent.
• The mortality rate was extremely low – only one in 57,000 cases.
• The overall risk of serious complications in an accredited office surgical facility is comparable with the risk in a freestanding surgical center or hospital ambulatory surgical facility.

You will also be evaluated for other factors that may increase the risk of blood clots. These include:
• being extremely overweight
• having recent traumatic injury
• any disorder of the heart, lungs or central nervous system
• a history of cancer, recurrent severe infection or genetic problems that affect blood clotting
For women, additional risk factors include:
• taking oral contraceptives or having recently ceased taking them
• undergoing hormone-replacement therapy
Plastic Surgery Today
Cosmetic Surgery is becoming more and more popular throughout the United States. Each year, several million Americans undergo surgery to improve their appearance. A recent survey published in Psychology Today indicates that 40 percent of Americans are dissatisfied with the shape of their noses and 25 percent are dissatisfied with the shape of their chins and necks. Furthermore, 30 percent of cosmetic surgery is performed on men, and this percentage continues to increase.
More and more people are realizing that cosmetic surgery is now affordable. They recognize plastic surgeons are highly skilled specialists with specific training and an understanding of today’s aesthetics.
More than ever before, senior citizens have gained greater respect and a more active role in society – our seniors are living longer, staying fit and leading more active lives. Unfortunately, the aging process persists, leaving people looking older than they feel. Is it any wonder than that many are turning to cosmetic surgery to restore a more youthful appearance?
Today’s America emphasizes a more youthful appearance regardless of one’s chronological age. The business community commonly chooses the more attractive individual to fill an available position. A recent ABC documentary report clearly depicted an overwhelming preference for hiring a more attractive person if two applicants otherwise had exactly the same credentials.
Clearly, many patients who undergo cosmetic surgery do so for economic reasons. Not only is this true for the fashion model, public figure, entertainment personality, corporate executive or professional person, but for anyone whose work or lifestyle requires that they interact with the public. A renowned psychologist reports that for students, “good looks affect school grades.” Furthermore, he states that one’s appearance can also “determine who will become friends, and affects the probability of prosperity…”

Surgical procedures which were once thought to be “only for the rich and famous” are now commonly affordable and undertaken by men and women with average incomes. People save up for a much desired cosmetic procedure similar to saving for a piece of jewelry. These people feel that they are investing in themselves to improve their self-image and lifestyle. They recognize the affordability of cosmetic surgery and its potential returns.
Goals and Expectations
Prior to undergoing any plastic surgery procedure, the patient must possess a realistic attitude based on emotional maturity:
• The goal of surgery is improvement, not perfection. Any patient expecting perfection is not being realistic and should not have the procedure performed.
• Not every patient is a good candidate for surgery. Surgery is not recommended for everyone who requests it.
• A surgeon is a physician working within the biologic limitations of healing. The degree of success depends not only on the surgeon’s skills but also the age, health, skin texture, bone structure, and the specific problems and expectations of the patient.
• Understanding the above limitations, both the surgeon and patient may project the possible outcome.
Examine the One Step Theory
of Plastic and Reconstructive Surgery:

• Should all go well, a one step improvement would be a reasonable expectation.
It would be unethical for any physician to guarantee the results of any treatment performed. The only guarantee that can be made is to do the best work possible for the patient.
An unrealistic motivation for cosmetic surgery precludes satisfying results. Although improvement in appearance may be psychologically beneficial by increasing self-esteem and self-confidence, cosmetic surgery is not the cure-all for all problems. Particularly, if one blames his or her appearance for lack of success or happiness in life, the patient’s expectations may be surgically unobtainable or too risky. Each person is encouraged to discuss any concerns or fears with their surgeon.
The patient should not expect to receive universal approval from family, friends, and acquaintances after the surgery is performed.
Although pain and discomfort following cosmetic surgery are relatively small, the patient needs the maturity to accept any postoperative condition as temporary. Swelling, discomfort, firmness, and discoloration are typical for a short time after surgery.

Any incision heals together by producing a scar. The surgeon has control over placement of the scars but no control over the healing process once the surgery is completed. In the initial healing period, scar lines will be pink and lumpy. They usually fade and become pale with time. While significant improvement can be seen in the first few weeks, subtle changes continue for the following year.
Finally, the patient’s attitude and health and adherence to the pre- and postoperative instructions play an important role in the success of the surgery. Each patient is strongly encouraged to see their personal physician for a check-up before surgery. Patients having eye surgery should see their eye doctor for an examination and visual field exam before having surgery.

Minor facial asymmetries are common amongst most people. Noting these subtleties before your consultation is imperative to understand the limitations of surgery.
If you are considered low risk, your doctor may simply ensure that you are positioned on the operating table in a way that allows for adequate blood circulation to the legs. If you are of moderate or high risk for developing blood clots, you may also be advised to wear elastic stockings before, during and after your procedure, or to take special anti-clotting medications. Compression devices on the legs may be used during surgery to support your normal circulation.

Costs of top plastic surgery procedures

2001 STATISTICS (National Average)

Botox® injection $387
Breast implant removal $2,086
Breast augmentation $3,437
Breast lift $4,053
Breast reduction $5,508
Breast reduction in men $3,184
Buttock lift $4,720
Cellulite massage treatment $160
Cheek implant $2,694
Chemical peel $516
Chin augmentation $2,024
Collagen injection $333
Dermabrasion $1,590
Ear surgery $2,914
Eyelid surgery $2,666
Facelift $5,968
Fat injection $1,053
Fibril injection $440
Forehead lift $3,032
Laser hair removal $355
Laser skin resurfacing $2,241
Laser treatment of leg veins $402
Lip implants $1,701
Liposuction $2,704

Lower body lift $7,625
Microdermabrasion $146
Rhinoplasty $4,047
Sclerotherapy $317
Thigh lift $4,487
Tummy tuck $4,917
Upper arm lift $3,527

Plastic Surgery Mistakes

Plastic surgery mistakes can occur during any procedure, performed by any doctor, although a number of plastic surgery mistakes can be avoided through proper screening by the patient. Some examples of plastic surgery mistakes include improperly performed procedures, surgical errors, and poor post-operative care.

Plastic surgery mistakes in facial procedures are generally the most noticeable and often the most difficult to repair. Plastic surgery mistakes made in facial plastic surgery can leave the patient looking wooden or unnatural, and some plastic surgery mistakes result in partial or full paralysis through nerve damage or tightened skin tissue. Plastic surgery mistakes in implant surgery can result in gross disproportion, asymmetry, and dangerous implant leaks. Some plastic surgery mistakes cause excessive scarring, or hardening of body tissues.

Plastic surgery mistakes in other parts of the body may be easier to mask, but victims of plastic surgery mistakes deal with many of the same issues, regardless how visible the results of their plastic surgery mistakes may be. The problems of living with the evidence of plastic surgery mistakes are not just physical; individuals suffer emotional and psychological trauma as well. Many plastic surgery mistake victims feel guilty or think that they are being punished for vanity.

Many plastic surgery mistakes can be fixed, and there are physicians who specialize in surgically repairing plastic surgery mistakes. Individuals who are seeking plastic surgery can help reduce the chance of plastic surgery mistakes by ensuring that their physician is fully accredited and certified. In the case of a plastic surgery mistake, a reliable physician will often correct the problem at no additional cost.

The gain
Liposuction or removal of fat may pose special challenges.
“If a patient comes in who see-saws their weight — 50 pounds up and 50 pounds down — and they want liposuction, I make sure they tell me about nutrition and exercise habits because liposuction is just one moment in time and they have to be able to maintain the weight loss after surgery”.
“If I remove two to three pounds of fat from their abdomen and they gain 20 pounds, I can’t predict where the weight gain will go,” she says.
“Most people are overweight,” he says. “Liposuction does not replace weight loss and it isn’t going to make you thin, but we can improve contours at your current weight,” he says. “If the outside of your hips have extra bulges and it really affects the way their clothes fit, liposuction can help your clothing fit better and may drop a size and look prettier — and that’s a good thing.”

Plastic Surgery: A Scientific Way to reach art
Relation of Plastic Surgery with Religion and God

As priest and prophet say the plastic surgery is totally wrong because they think that no God book has mentioned something about surgery we have to accept ourselves as we are. Because after god no one is complete. So we conclude that religions are against plastic surgery.

Right or Wrong
Plastic surgery is right and wrong. Right in few situations for example after an accident (car accident, fire accident, etc…) and wrong if we had a surgery without a reason for example as we have now, all girls are same because 99% of them have made the nose surgery and many things for changing their look.

Knowing When to Say No is the best solution of plastic surgery. Someone who is looking at themselves appropriately with reasonable expectations is typically the best candidates.
The bottom line? If you are considering plastic surgery, “be sure that the procedure you are asking the doctor to do will meet your goals”. “Make sure that the surgeon you choose is certified by the American Board of Plastic Surgery (ABPS) and a member of ASAPS”.


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