PLASTIC SURGERY UPDATE

Many advances over the last five years have contributed to the safety and success of plastic surgery procedures. Newer drugs and developments in anesthesia make surgery simpler, safer and more pleasant for the patient.

Cosmetic surgery, though highly elective and performed on healthy patients, should nevertheless be approached with a serious and informed attitude. When choosing a surgeon, be sure that he or she is certified by the American Board of Plastic Surgery. Advertising methods and computer imaging are enticing, but do not take into account the ability of the surgeon. When you meet with a prospective surgeon, determine whether you are able to talk to him or her, and if he or she is receptive to your questions.

There are certain issues every plastic surgery candidate must discuss with the surgeon before under-going any procedure:

• What is the nature of the operation. What does it involve?
• What are the potential complications? Every legitimate surgeon will thoroughly explain the risks involved with any surgery.
• The cost. Fees vary widely geographically peaking in major urban areas.
• The nature and length of convalescence.
• Insurance coverage. Cosmetic surgery is usually not insurance reimbursable though there are exceptions.
• Surgery that involves the correction of a medical problem is often covered.

Common Cosmetic Surgery Procedures

Blepharoplasty or Eyelid Tuck

Blepharoplasty, the removal of skin and fatty tissue from the upper and lower eyelids, is usually performed in the doctor's office with the patient receiving a local anesthetic while under sedation. During the procedure, which takes about an hour, incisions are made just beneath the lower lash line and in the crease of the upper lid. Three to five days after the procedure, sutures are removed. The eyelid area can remain black and blue for a week to ten days. There is a bit of discomfort the first night but it is not a painful recovery. Blepharo-plasty is not insurance reimbursable.

Facelifts

Many people are not waiting for that fiftieth birthday to have their first facelift. Patients in their early forties are choosing to have this procedure. The results can last from five to seven years - not quite as long as eyelid surgery - depending on the patients age and skin elasticity Most facelift surgery is performed as an outpatient procedure requiring three to four hours under a general anesthetic or intravenous sedation. Incisions are more extensive than those for blepharoplasty but are equally well-concealed along the hairline and behind the ears. Recovery takes about three weeks. Patients are warned not to take aspirin for three weeks prior to the operation since aspirin can cause excessive bleeding. Facelift candidates should also be aware that smoking and facelifts do not mix. Smoking constricts the blood vessels and can cause heal-ing and scarring complications.

Rhinoplasty or Nasal Surgery

Today rhinoplasty is geared toward straightening the nose and producing a natural appearing nose, rather than over-reducing it to an obvious and often inappropriate pixie/ski jump combination. The procedure takes about an hour and can be performed in the doctor's office or in the hospital. Patients convalesce for two weeks and may not exercise for three weeks following the operation. Nasal surgery is often insurance reimbursable if the correction of a functional breathing impairment is performed at the same time. Note: Candidates for nasal surgery should be fifteen or older, the age at which facial bone growth is complete.

Liposuction

Liposuction is not the surgical answer to dieting. Rather, this procedure, which has become the most common type of plastic surgery performed in the U. S. today focuses on and corrects regional abnormalities. Patients in their twenties and up are having fatty tissues removed from "saddle bags," the fullness under their chins, knees, thighs, and "love handles." Liposuction is usually performed in the surgeon's office under IV sedation or a general anesthetic. In our office we have been using epidural anesthesia success-fully. This enables a patient to have total comfort during the procedure and to go home without the potential complications of general anesthesia. Keep in mind that, in many cases, a future touch-up is often necessary to achieve the best results. Candidates for liposuction must have good skin elasticity if the skin is to contract back properly after the procedure. Liposuction generally is not insurance reimbursable.

Decide With Care

The decision to have plastic surgery is a personal one and depends on your individual values. The most satisfied patient is one whose decision to undergo plastic surgery is self-motivated, not the result of pressure from a spouse or parent. And remember, choose a Board Certified plastic surgeon as carefully as you would your internist or family physician.

By John E. Sherman, M. D.

Dr. Sherman is Assistant Clinical Professor at Mount Sinai School of Medicine. He is also Attending Surgeon at Doctors Hospital in New York.