Cosmetic surgery

Cosmetic Surgery (also called Aesthetic Surgery) is the field of surgery in which operations are aimed to improve appearance, that is, to create beauty.

"Aesthetic surgeons, in the normal practice of their specialty, routinely alter the otherwise acceptable physical form of the patient toward the arbitrary and stylized visages thought desirable either by the patient or by the community in general" (Isenberg JS. The legacy of Narcissus.[comment]. [Comment. Letter] Plastic & Reconstructive Surgery. 110(7):1815; author reply 1815-6, 2002 Dec. UI: 12447085). Although cosmetic procedures do not cure disease, they can have a tremendously beneficial effect for the patient who undergoes them, providing that patient expectations are reasonable and that a satisfactory postoperative result can be obtained. When self-image is improved, a real benefit is almost always conferred. In the case of people whose livilihood depends on photogenicity, or another aspect of personal appearance; aesthetic surgery can offer the same kind of advantages as exceptional grooming or eye-catching garments. In these circumstances the financial cost of the surgery is often viewed as a business expense, whether or not it is deducted as such - and the time and discomfort involved in undergoing surgery is an investment in a career.

Cosmetic surgery has been offered to prisoners by philanthropists, and by some of the surgical training programs in university affiliated residency programs that provide healthcare to inmates. Removal of gang related tattoos, reduction of scars, and repair of nasal deviations and other physical momentoes of trauma from previous assaults can, at least theoretically, help individual rehabilitation. There are certainly individuals who have experienced a tremendous benefit by being freed of these stigmata. In other cases, surgical modification of an unusual feature present since childhood, like a prominant nose or a receding chin can be a expedient alternative to an ongoing struggle to ignore them. When congenital anomalies (birth defects) are severe, or the scarring from trauma causes obvious deformity, then surgical improvement of appearance is not called cosmetic surgery, but is classed as a reconstructive procedure. In many countries, reconstructive surgery will be covered by private insurance or government health plans.

The removal of lax skin, resurfacing of sun damaged skin, and tightening of subcutaneous tissues can dramatically remove signs of aging with minimal risk and discomfort.

On the other hand, individuals who undergo cosmetic surgery in an attempt to gain affection from disinterested mates, or who falsely assume that a deep dissatisfaction with current life will be changed by cosmetic procedures can suffer harm from undergoing surgery that is far beyond the discomfort of postoperative healing. Well-trained ethical aesthetic surgeons are always interested in why their patients desire surgery. Such surgeons, far from "selling" the idea of surgery, will refuse to operate on a patient with unreasonable expectations no matter what financial reward is offered.

Cultural & ethnic considerations

Lips

In the 21st Century very full lips are considered to be so attractive that procedures to "fill out" the lips are among the most popular procedures requested of aesthetic surgeons. Not only are varous fillers injected into the lips, but traditional "cold knife' plastic surgery is used to give more lasting results than the fillers can currently provide. (Mutaf M. V-Y in V-Y procedure: new technique for augmentation and protrusion of the upper lip. [Journal Article] Annals of Plastic Surgery. 56(6):605-8, 2006 Jun. UI: 16721070). All of these procedures are generally safe and effective in expert hands, but, interestingly,there was little demand for lip augmentation a generation ago. That's because the fashionable face was different then.

Fifty years ago, what are now considered beautifully full lips were more often viewed as excessively thick lips. Rather than lip augmentations, surgeons concentrated on "lip thinning operations" to make the mouth smaller and more delicate. Lip reduction operations were a standard part of the facial plastic surgeons repetoire in the 1960's and 1970's, and were the cosmetic lip surgery featured in the plastic surgical textbooks of those times. Currently, as demand has changed, such procedures receive scant mention in the medical literature.

Noses

"Correction" of the ethnic nose

In the 19th and in part of the 20th century, a Northern European Caucasian nose of certain proportions was the one and only aesthetic ideal. In the earlier portion of that period, outright discussion of the unattractiveness of semetic and negro noses was printed in both lay and professional publications. In the later portion of the 20th Century, wide and hooked noses were no longer overtly labelled as a detrimental mark of ethnic origin, but still, such features were routinely described as showing "deformities". Patients sought corrections of these attributes that surgeons were willing to provide.

"A 1996 manual describing procedures for altering ethnic noses, for example, indicates that correction of the "Jewish nose" requires "a classic rhinoplasty with lowering of the dorsum, narrowing of the bony pyramid, refinement and elevation of the excessively long hanging tip. Another recent manual, while refraining from explicitly using the Jewish nose as a diagnostic category, notes that 2 patients with noses that "have acute nasolabial angles, plunging tips, or foreshortened nasal tip pyramids" were "of Jewish ancestry" or of "Jewish descent." " (reference for quote:Preminger B. msJAMA: The "Jewish nose" and plastic surgery: origins and implications. [Journal Article] JAMA. 286(17):2161, 2001 Nov 7. UI: 11694162). The recognition of beauty can change over time, as ethnic characteristics that were once seen as "ugly" because yhey were a mark of a difference that was held undesireable by the general society become appreciated as intolerance disipates. For example, the actress Jennifer Grey experienced a set-back in her career when she had a cosmetic rhinoplasty that changed her distinctive natural nose from one with a delicate downward hook into one with a diminuitive button tip.

Jaw lines

Whereas a square angle of the jaw is a mark of great beauty in both men and women of all races in the West, in Asia, in women, the opposite is true. A strong jaw, with a square angle, is traditionally viewed as unsightly. "An operation to correct a square angle into a round, smooth angle" is offered by aesthetic and reconstructive surgeons practicing in the East.(reference for quote:Satoh K. Mandibular contouring surgery by angular contouring combined with genioplasty in orientals. [Case Reports. Journal Article] Plastic & Reconstructive Surgery. 113(1):425-30, 2004 Jan. UI: 14707669) Baek, S. M., Kim, S. S., and Bindiger, A. The prominent mandibular angle: Preoperative management, operative technique, and results in 42 patients. Plast. Reconstr. Surg. 83: 272, 1989 Lee DG. Song CW. Kim SG. Lee YC. Cho BO. A simple technique for reduction gonioplasty. [Letter] Plastic & Reconstructive Surgery. 111(2):951-2, 2003 Feb. UI: 12560737

Facial cosmetic surgery

Rejuvenation of the aging face

Botulinum toxin

"What is so different about the injection of cosmetic botulinum toxin from other injections? Simply stated, neurotoxin injections are a surgical procedure—because the results depend entirely on the injector's knowledge of the underlying muscular anatomy and pharmacology as well as the principles of aesthetics." (reference for quote:Carruthers JD. Caveat emptor (buyer beware).[comment]. [Comment. Editorial] Archives of Dermatology. 138(9):1243-4, 2002 Sep. UI: 12224991)