Cosmetic surgery

Cosmetic Surgery (Aesthetic Surgery) is the field of surgery in which operations serve to improve appearance rather than to cure disease. "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.

Plastic surgery encompasses both cosmetic and reconstructive surgery.

Patient selection in cosmetic surgery

All surgery has risks, but when the potential benefit to the patient is greater than the potential harm, there is general agreement (among patients, health care professionals, and society) that surgery is indicated. Cosmetic surgery presents a special situation. Although many cosmetic procedures are only minimally invasive, like collagen injections, others are major procedures that can require hours of operating time and might even entail blood transfusions or the need for life support systems in the immediate postoperative period. When it comes to operative procedures, none are without at least theoretical risk to health and even to life, and that risk is substantial in major surgery.

Given that potential harm exists, how can surgical treatment ever be justified when no illness is present? Although cosmetic procedures do not remedy illness, they can significantly improve the quality of life. When the risk of a particular cosmetic procedure is significantly less than its perceived benefit, then, again, there is agreement that the surgery is indicated. In cosmetic surgery, however, the acceptable risk of harm to the patient is generally minimal or very low. High risk procedures for cosmetic benefits are usually undertaken only when the appearance of a person precludes normal social interaction or is the result of trauma or disease, and when that is the case, the surgery is considered reconstructive rather than cosmetic.

One of the most important aspects of cosmetic surgery is patient selection. That topic is covered in every surgical textbook and every training program, because the ultimate success or failure of cosmetic surgery is as dependant on proper patient selection for a given operation as are the technical considerations of performing that surgery. When 1) patient expectations are reasonable and 2) a satisfactory postoperative result can be obtained at little risk; cosmetic surgery is indicated, and a satisfactory outcome can be anticipated. In other circumstances, a patient may not be a candidate for the specific procedure sought or for any elective cosmetic surgery at all. Those other circumstances occur when an individual possesses certain attributes that make a good technical result very unlikely to occur, or to satisfy the patients wants even if it does occur, or that put the patient at unacceptably high risk for complications from surgery.

Benefits of Cosmetic Surgery

An improvement in self-image is a real benefit to the patient having successful cosmetic surgery, but is not likely to be perceived by every individual seeking a cosmetic procedure. A change in appearance alone is never enough to confer a good self-image to a person who lacks one. In general, cosmetic surgery is contraindicated in a person with a deep seated self-loathing who hopes that somehow changing the shape of a part of the body will transform his entire attitude or life. No matter how the outcome of the surgery may be seen in another observer's eyes, patients who are deeply dissatisfied with themselves are likely to see the results as a failure, and remain dissatisfied with themselves.

In patients who are bothered by a specific feature, and have a healthy self-image, there is still another consideration before an operation is scheduled. Is the desired result one that is likely to be obtained? Depending on skin type, age, and other individual factors, the look that a particular patient is hoping for may not be attainable. In such cases, the patient and surgeon together often agree that it is preferrable not to proceed with surgery.

In the case of people whose livilihood depends on personal appearance, photogenicity or stage presence, aesthetic surgery can offer the same kind of advantages as exceptional grooming or garments. In these circumstances the financial cost of the surgery is often viewed by the patient as a business expense (whether or not it can be deducted as such), - and the time and discomfort involved in undergoing surgery is viewed as a career investment. If, in fact, the desired change in appearance is one that is likely to be technically achieved by procedures that do not confer an undue risk on the patient, then the patient is considered a candidate for cosmetic surgery.

In some specific situations, aesthetic surgery is performed in order to help increase self-esteem. For example, removal of gang-related tattoos, reduction of scars, straightening of nasal deviations and other physical momentoes from previous assaults can help facilitate 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 a continuing struggle to accept the presence of these features. The droop of soft tisues and change in conformation that comes with age can lend fatigue to anyones' appearance, and a sense of rejuvenation can be experienced with successful correction. However, when low self-esteem is pervasive, then the results of surgical attempts to improve appearance are unlikely to help the individual. Even when results are considered excellent by others, the patient, in that situation, may be unable to acknowledge improvement but instead be excessively bothered by minor scarring or other changes and experience additional loss, rather than gain, of self-esteem.

Risks of Cosmetic Surgery

Well-trained ethical aesthetic surgeons are always interested in why their patients desire surgery. Such surgeons, far from "selling" the idea of surgery, will try to dissuade a patient with unreasonable expectations from having surgery, no matter what financial reward is offered. This is not entirely altruistic, it has been said that “a plastic surgeon makes his money from operating and his reputation from refusing to operate.”(reference for quote:Widgerow AD. First signals.[comment]. [Comment. Editorial] Plastic & Reconstructive Surgery. 113(7):2206-10, 2004 Jun. UI: 15253216).

The ethical surgeon will employ techniques of Shared Decision-making, which includes undertaking a frank discussion of the risks and benefits of cosmetic surgery with the patient, and then helping the patient to make a decision that serves the patient's best interests.

Human beauty : universal attributes

Symmetry

Facial cosmetic surgery

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 (2006). "V-Y in V-Y procedure: new technique for augmentation and protrusion of the upper lip". Ann Plast Surg 56 (6): 605-8. PMID 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.

Whereas the actress Angelina Jolie (pictured left) is thought by many to have nearly perfect feminine lips in 2007, the actress Grace Kelly was much closer to that ideal in 1967, at the time the picture to the right was taken. Both women are generally considered to be great beauties, yet each of them, as pictured in these photographs, might also be considered legitimate candidates for cosmetic surgery.

Forty years ago, what are now considered beautifully full lips were then viewed as excessively thick lips.Rather than lip augmentations, surgeons concentrated on "lip thinning" operations to make the mouth appear 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.Template:Fact Currently, as demand has changed, such procedures receive scant mention in the medical literature.

One could speculate that if Angelina Jolie could be brought back in time to be examined by a cosmetic surgeon in Grace Kelly's era, she might be offered a lip reduction to improve her appearance. On the other hand, Grace Kelly, at the peak of her beauty, might be seen as a candidate for lip augmentation by a contemporary cosmetic surgeon. An awareness of how opinions change over time about what constitutes beauty is important for both the surgeons and the patients involved in cosmetic surgery. Permanent changes in the face and body made to accomodate a preference that is temporary is liable to eventually be regretted by each.

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 western worldTemplate:Fact. In the earlier portion of that period, outright discussion of the unattractiveness of semetic and negro noses was printed in both lay and professional publicationsTemplate:Fact. In the later portion of the 20th Century, wide and hooked noses were no longer so overtly labelled as a detrimental mark of ethnic originTemplate:Fact, but still, such features were routinely described as showing "deformities". Patients sought corrections of these attributes that surgeons were willing to provideTemplate:Fact.

"A 1996 manual Template:Fact 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."

The recognition of beauty can change over time, as ethnic characteristics that were once seen as "ugly" because they were a mark of a difference that was held undesireable by the general society become appreciated as intolerance dissipatesTemplate:Fact. For example, the actress Jennifer Grey experienced a set-back in her career Template:Fact when she had a cosmetic rhinoplasty that changed her distinctive natural nose (with a delicate downward hook) into a more generic nose with a diminuitive button tipTemplate:Fact.

Surgical techniques

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 WestTemplate:Fact, in Asia, in women, the opposite is trueTemplate:Fact. A strong jaw, with a square angle, is traditionally viewed as unsightly.

Rejuvenation of the aging face

The removal of lax skin, resurfacing of sun damaged skin, and tightening of subcutaneous tissues and facial muscles can dramatically remove signs of aging with minimal risk and discomfort. Rejuvenation surgery is often combined with various types of skin resurfacing or dermal fillers. Reversal of a prematurely aged face can successfully raise self-esteem. .

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."

Body Recontouring

Breast augmentation and mammapexy ("lift")

Schwarzman E. Goldan S. Wilflingseder P. The classic reprint. Die Technik der Mammaplastik (the technique of mammaplasty). [Biography. Historical Article. Journal Article] Plastic & Reconstructive Surgery. 59(1):107-12, 1977 Jan. UI: 318746

Breast augmentation techniques and resultant shapes have been revised since the invention of the procedure in the 1960s.

"Belly tuck"

Abdominoplasty

A 2003 study of abdominoplasty patients indicated significant improvements in body image, as measured by several different outcomes. There were no changes reported in self-esteem or other psychological components.

The patient's part in cosmetic surgery

Although cosmetic surgery is traditional branch of Plastic Surgery, in most countries of the world, any physician licensed to practice any sort of surgery can legally perform cosmetic procedures.

Smoking is especially deleterious for plastic surgery patients such as cosmetic surgery recipients, since cigarette smoke components are known to retard wound healing.

Honigman RJ. Phillips KA. Castle DJ. A review of psychosocial outcomes for patients seeking cosmetic surgery. [Review] [62 refs] [Journal Article. Review] Plastic & Reconstructive Surgery. 113(4):1229-37, 2004 Apr 1. UI: 15083026

Rohrich RJ. Mirror, mirror on the wall: when the postoperative reflection does not meet patients' expectations. [Journal Article] Plastic & Reconstructive Surgery. 108(2):507-9, 2001 Aug. UI: 11496196