Deciding to undergo plastic surgery
“To grow old is desirable; to look young while doing so is enviable”
Deciding to undergo plastic surgery can be a difficult decision and most people take years before they finally seek consultation. The reasons vary and may include financial considerations, fear of doctors’ offices, and guilt about desiring elective procedures. Plastic surgery can be costly and certainly can be considered a luxury for some. However, if it can be afforded, we don’t feel that elective aesthetic surgery should be a source of guilt or shame. In our society, people feel younger and take better care of themselves than ever before. Likewise, they want their appearance to reflect their vitality and Plastic surgery is often chosen as an award to oneself after reaching a goal whether it is physical, spiritual or professional. These are perfectly fine reasons to consider plastic surgery. On the other hand, plastic surgery should not be an obsession. Plastic surgery should not be done to please someone other than yourself. It is a decision that should be contemplated and taken seriously. Perfection is not achievable and should not be your goal. In fact, most people only desire an enhancement or improvement of a problem area. Plastic surgery does carry some risk and patients must be mentally prepared to accept this and endure the necessary steps in the event of a complication or need for revision.
Profile of Aesthetic Surgery Patients
“Display your age through your wisdom and knowledge, not your appearance”
Plastic surgery patients encompass as broad a group of patients as any found in medicine. These patients range from the completely healthy seeking improvement in the appearance in a problem area, to the critically ill requiring reconstructive procedures. Contrary to popular belief, there is no one type of person who seeks aesthetic surgery. They represent all socioeconomic, geographical, ethnic, national, and professional backgrounds. On any given day we expect to see patients who desire attention to any body area, head to toe. Most of our aesthetic patients are healthy and lead active lifestyles. In addition, most of our aesthetic patients have very positive mental outlooks. Many have decided to consider plastic surgery to address problem areas after weight gain or pregnancy which can’t be corrected with diet and exercise. Some come to address a noticeable area which they were born with but no longer desire, such as the “family ears.” Others desire a competitive edge in their vocation. Many just want to “look as young as they feel.” Our patients have included pilots, students, attorneys, physicians, housewives, personal trainers, entertainers and many, many others.
Plastic surgery patients must be evaluated individually and the approach to treating their request must reflect this as no two individuals are exactly alike. Your appendix may or may not look like your neighbors; chances are pretty good however, that your nose and ears definitely do not! Most patients seeking plastic surgery are not seeking perfection. Everyone has flaws as this is human. In fact, on most people, even dual parts such as ears, eyes, cheeks and breasts are usually larger on one side than the other. People do, however, seek plastic surgery if there is a significant disparity in appearance either between two body parts or the norm. This again is a very individual decision and we feel that it’s not our job to judge. The request we see vary and is based on ethnic, geographical, and social taste. An African-American woman may desire a completely different result than an Asian, Latino or Caucasian woman. Likewise, a woman from New York may desire a completely different result than a woman from Los Angeles.
As a rule, patients should not seek elective plastic surgery while experiencing drastic weight changes, gain or loss, or undergoing active emotional issues. Although we don’t profile our patients, we do recommend that patients undergoing instability whether financial, professional or emotional consider postponing elective surgery until they feel that they are able to make an informed decision and are mentally prepared to endure the recovery period. Patients who are felt to not qualify for treatment due to psychological considerations are referred to recommended therapist for assistance. Plastic surgery should be considered a reward to yourself. It should not be considered an absolute necessity. Aesthetic surgery may make you feel less conscientious about your appearance, feel more confident in certain situations, look better in certain clothes. Plastic surgery will not make you happy and should not be sought for this reason. In our opinion, happiness is a state of mind. This can never be assured to you by a surgical procedure. In my experience, most plastic surgery patients are very pleased with their decision and outcomes.
Anesthesia for Plastic Surgery
Administration of anesthetics for plastic surgery procedures will vary by surgeon and type of procedure performed. Some procedures may be performed in the office with local anesthetic without an anesthesiologist. Many procedures may also be performed under IV sedation in a outpatient surgical facility. All cases requiring general anesthesia are performed by a board certified anesthetist. In such cases, a separate fee for anesthesiologist and facility use will be passed on to the patient. It is our feeling that such fees are inconsequential in the big picture and well worth the peace of mind in knowing that a specialist is dedicated to delivering anesthesia to provide a safe experience. There can be no compromises in this area. In our experience, having an anesthetist which whom both the surgeon and patient feels comfortable, with is part of the total experience of undergoing plastic surgery and these individuals have been invaluable in helping to alleviate apprehension, pain and post operative nausea.
Smoking and Plastic Surgery
The metabolic by-products of smoking have been scientifically shown to negatively affect soft tissue perfusion. This has possible adverse results in plastic surgery including compromised healing of wounds, fat necrosis, infection and total loss of skin or soft tissue at the site of surgery. It is therefore imperative that total cessation of smoking is practiced for at least 4 weeks prior to elective plastic surgery. Smoking is an absolute contra-indication in many elective plastic surgery procedures including facelift and rhinoplasty.
Recovery after plastic surgery procedures
Recovery after plastic surgery procedures differs from that of other forms of surgery. This is due to the fact that although internal healing may be stable by six weeks, the “success” of many plastic surgery procedures rely on the external appearance. Patients must ask their surgeon in regards to healing and activity level on an individual basis. However, in general, light or restricted activity is practiced for 6 weeks. Shape and appearance will be become noticeable at 3 months. Scars will be pink or red for several months after surgery and sun avoidance must be practiced to prevent permanent discoloration. Currently, tape containing silicone gel is the most effective in preventing thickened scars. The final result for most plastic surgery procedures including resolution of swelling and scar discoloration is one year.
Diabetes and Plastic Surgery
Diabetic patients, particularly those who are insulin dependent, have a higher risk of infections, skin loss due to poor perfusion and difficulty with wound healing. If elective surgery is chosen, it is imperative that the diabetic history is communicated to the primary care physician to optimize measures to prevent potential complications. Strict adherence to recommendations must be followed prior to undergoing elective surgery as well as during the post-operative period. Some procedures may be contra-indicated in patients who require daily insulin supplementation. In our experience, most patients whose diabetes is controlled by diet or oral hypoglycemics, heal uneventually. Diabetes is therefore not an absolute contra-indication to aesthetic surgery.
HIV Positive patients and Plastic Surgery
The remarkable medical advancements in recent years has resulted in tremendous strides in the management of HIV. Advances in anti-viral medications have contributed to much of this progress. However, there are now recognized physical attributes which are felt to be secondary to anti-viral use. These include facial wasting and fatty tissue deposits under the skin. These problems can be effectively treated with plastic surgery techniques such as injectible filler, implants and liposuction. The physical stigmata of the disease can therefore be eliminated. HIV is not a contra-indication to plastic surgical procedures.
Preventive health measures are always a concern and Dr. Coleman utilizes board certified internists to provide medical clearance for patients based on procedure, age and past medical history. For the benefit of some patients, psychiatric clearance will be arranged prior to undergoing elective procedures.