Cosmetic Surgery: Nose To Toes

By Kaaren Valenta

Cosmetic surgery has become so mainstream that 11.9 million cosmetic procedures were performed in the United States alone last year, and many were not performed by plastic surgeons.

Gynecologists, dermatologists, general surgeons, and even ophthalmologists are among those who are doing cosmetic surgery because they see it as a lucrative opportunity, a situation that is troubling to many plastic surgeons.

“I’m not sure I’d want a gynecologist doing botox and collagen injections,” said Dr David M. Goldenberg, MD, a plastic and reconstructive surgeon with Advanced Cosmetic & Plastic Surgery at 107 Newtown Road in Danbury, at a program sponsored by the St Rose Parish Nurse Ministry at the C.H. Booth Library.

“Anyone who is considering cosmetic surgery should look for a doctor who is board-certified in plastic surgery,” he said. “And by not just any board. Be sure it is the American Board of American Specialties. That means the doctor has completed training in general surgery and plastic surgery, taken a written exam, practiced for two years, then taken an oral exam. The plastic surgeon then must be recertified every ten years by taking another exam.”

Look for the certification on the wall of the physician’s office. “If it isn’t there, go somewhere else.”

Dr Goldenberg said board certification isn’t the only caveat involved with cosmetic surgery.

“Not every new procedure is a good procedure,” he said. “Some disappear from news articles because they don’t work.”

Face and neck lifts, eyelid lifts, and brow lifts are among the most popular procedures among both women and men. Rhydectomy, or face lift, involves the removal of wrinkles and signs of aging from the face. It usually involves the removal of excess fat, the tightening of underlying muscles, and redraping the skin on the patient’s face and neck.

The average age in the United States for face lifts is 57; for eyelifts, 48.

“Patients who were beautiful when they were younger are destined to get good results with face lifts if they are relatively healthy, with great facial aesthetics and good skin,” Dr Goldenberg said. “It is often a question of relative health — patients who are younger than their years. That includes some people in their 70s and 80s who are healthy — those who are not on many medications and who have not abused their skin.”

Eyelid surgery or blepharoplasty is a corrective surgical procedure involving the reshaping of the eyelid through the removal of excess tissue. The procedure is used to correct drooping upper lids and puffy bags below the eyes by removing fat, as well as excess skin and muscle, from the upper eyelid and or lower eyelid.

“Eye lifts are the most common procedure for men,” Dr Goldenberg said. “Most are in their 60s and 70s. The surgery takes between one and a half and four hours. Stitches are in for three or four days, and it takes two weeks for the swelling and bruising to go down.”

These procedures most commonly are done in office operating rooms rather than hospitals because of the costs.

“Plastic surgeons don’t have to maintain intensive care units or hospital beds, so it brings down the cost to the patient,” Dr Goldenberg explained. “But be sure it is a certified, licensed operating with general anesthesia, usually administered by nurse anesthetists, and all the proper procedures.”

For patients who do not want surgery, botox often is an answer.

“Botox also is used around the eyes, and occasionally on the throat,” Dr Goldenberg said, explaining that because it essentially paralyzes muscles, it is not used for all types of cosmetic procedures. “Restylane is used around the mouth,” he said.

Nose reshaping, or rhinoplasty, is a common procedure but it has the biggest resurgery rate.

“Of every 100 people who undergo it, 30 percent will have a reoperation because they are not satisfied,” Dr Goldenberg said. “In those cases, the surgeon’s fee is usually waived and the patient only pays for the operating room and other costs.”

Liposculpture and breast augmentation also are popular procedures, generally done on an outpatient basis under sedation.

“Liposuction involves putting fluid into fat then using a special metal tube to remove the fat,” Dr Goldenberg explained. “The best results are obtained on the legs — hips, buttocks, outer thights — and perhaps the abdomen. On other places it does not work as well.”

The most common problems are complications, too much loose skin, and too much fat left behind or taken out.

“Plastic surgeons spend a lot of time talking to patients about what they can realistically expect,” Dr Goldenberg said. “Some patients need a tummy tuck rather than liposuction, or vice versa.”

In tummy tucks, or abdominoplasty, excess fat and skin are removed while the muscles of the abdominal wall are tightened.

“The belly button stays in place and the skin is moved,” Dr Goldenberg said.

Patients who opt for breast reduction surgery usually do it to alleviate head and shoulder pain and migrane headaches. “In some women it absolutely is a life-changing operation,” Dr Goldenberg said.

As much as half of the breast can be removed and statistics seem to show a lower rate of breast cancer in women who have had the surgery.

“Breast exams become easier and mammograms become easier,” he said.

Costs in Fairfield County average $7,000 to $9,000 for a face lift, but these costs may be triple that in New York City.

“It may be $20,000 to have a face lift done by the plastic surgeons who do the [movie] stars,” Dr Goldenberg said.

Compared with these costs, procedures like botox injections may seem like a bargain.

“Four hundred dollars for botox injections is not a lot if it lasts for six months,” he said. “Many people compare that to what they spend on makeup and haircuts and think that it is well worth it.”

Videotapes of Dr Goldenberg’s program, and other programs sponsored by the St Rose Parish Nurse Ministry, are available at the library.