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A - Z of Plastic Surgery - The Kindest Cut

Most Common Procedures 

Like it or not, we are judged first in life by our appearance.  We live in an ageist society where youth plays a very important role.  This is largely because we follow in the footsteps of the United States of America where people worship at the fountain of youth; where cosmetic surgery is the fastest growing medical specialty. 

Traditionally 90 per cent of plastic surgery operations have been carried out on women. 

But that too is changing fast as more and more men turn towards plastic surgery. 

As author Leah Feldon aptly wrote, “Let me say that I agree with you wholeheartedly, we should not be judged by our appearances….but we are, so get over it.” 

She is right. Tragically much research has gone into showing how people with pleasing looks are more popular, get better jobs and are far more self confident. 

We are bombarded with double messages wherever we turn.  Every cosmetic house boasts beautiful women demonstrating wrinkling and age reducing creams. We  watch fascinated programmes like Complete Makeover and Nip and Tuck, wherein a person, usually a female’s entire image is changed, seemingly overnight and we think, “If only….. If only I could….”    

Programmes like Complete Makeover, don’t point out that it is unrealistic and dangerous to spend so much time under having so much major surgery - sometimes within as short a period as 48 hours.  (Nor, do they honestly talk about plastic surgery being darn uncomfortable and downright painful.) 

Yet, mention even one facet of plastic surgery to our nearest and dearest and they usually balk at the idea. Often parents or children say, “Grow old gracefully.”  Too often our spouses tell us that they couldn’t bear to have us go under the knife, that they love us as we are.  

Yet we catch them gazing admiringly at women 20 years younger than themselves or us or at a woman of comparable age dramatically enhanced thanks to a bout of plastic surgery.  Sometimes they feel threatened or insecure by the idea of our having a cosmetic procedure. 

Or have you ever spent an evening with a few couples and heard ageing 50-something balding, overweight husbands not particularly aesthetic themselves, jokingly admire a twenty-five year old woman and say, “I wouldn’t mind having her shoes under my bed?”  

Sadly it’s frowned upon if a 50-something woman makes the same remark about a young man. The good news is that there is a rising reversal of attitude with growing numbers of men taking the plunge.  In the trendsetting USA it’s said as many as one in five plastic surgery operations are now performed on men.  And, as always, the rest of the Western world will follow.  

The male cosmeceutical (cosmetic products mixed with pharmaceuticals) industry is growing enormously, particularly with the choice of rejuvenating creams for male skins. Glamorous women don’t want to accept men who look like slobs, people are living longer and our lifespan in the workforce has been extended.  Looking youthful gives a man a far more competitive edge than being judged by his accumulated experience.  

Generally speaking it’s easy for us to tell ourselves that we should feel confident in accepting the way we look.  But it’s hard to do this in a culture wherein beauty and youth equate happiness and success.  That’s the message conveyed by TV and every magazine cover. Much research shows how people generally considered attractive are more popular land more lucrative jobs and have more opportunities for fun.  Those who are considered plain become isolated often, are excluded from friendship and sexual relationships.  The isolation part starts in school, robbing one of confidence for the rest of their life. 

But what qualifies us for plastic surgery?   How do we choose an appropriate surgeon? And most important of all what can we expect from going under the scalpel? 

Truth be told, cosmetic surgery can transform the quality of our life particularly if we feel we have a big nose, small or huge breasts, fatty bags under our eyes or an unsightly scar.

How To Make The Decision 

Many people will make this decision only once or twice in their lives.  It is a big decision and a highly personal one.

Plastic surgery should never be considered when it is made at the suggestion of others – particularly partners.  Ironically, most people don’t want their partner to have surgery, as mentioned above.  Paradoxically though, many people tease their partner about certain features so much that they drive them to consult a surgeon.  This is no reason for surgery to be undertaken. 

We shouldn’t have surgery because we are dealing with trauma like sexual abuse, or because of a crisis in our home-life or work, or because our partner has had an affair.

Changing one’s appearance under those circumstances will not really change life for the better. 

A surgeon should always advise against surgery when people have unrealistic expectations, or when they have a psychiatric condition called dysmorphobia (being convinced that you look ugly and misshapen regardless of what you have done.) 

We should have surgery because we feel that the old and ugly are the first to be rejected in our ruthless and competitive society, and we feel a surgeon can freshen, improve or help maintain our looks. 

South African plastic surgeon, Professor Alan Widgerow has a sign above his consulting room that reads “A plastic surgeon makes his money from operating and his reputation from refusing to operate”.  

Aint that the truth? 

In Professor Alan Widgerow’s book ‘A Cut Above The Rest’ he offers the following advice before one makes the decision to opt for surgery.: 

  • “Whose idea is the surgery?  Do you merely want to satisfy your partners’ superficial needs?  Is your partner looking for a trophy to display and how comfortable are you with that?
  • Are you trying to salvage a relationship with surgery?   If so it won’t work-look for help elsewhere.
  • Is the decision being taken independent of your partner’s input – and are you comfortable with that?
  • Is your partner more concerned about the cost than identifying your needs? Can you cope with the anticipated negativity of your partner throughout the process?
  • Can you recognize and overcome these potential obstacles?
  • Confront these issues with your partner before surgery.
  • Are you having surgery because of the age gap with your partner?  If so is your physical aging really apparent or is this a constant insecurity that rests at the back of your mind? Will surgery really cure these fears? Are your expectations realistic?  
  • Once the decision is made, assess your partners coping mechanisms with surgery.  If he panics, hates hospitals or clinics and their unique sights choose somebody else to accompany you.
  • Consult the plastic surgeons association website, make enquiries about your surgery and your surgeon.”  

The Risks

Once you have positively decided on surgery ensure you know what is involved and the risks. 

The results of cosmetic surgery vary.  We all hear horror stories from time to time, leaving people scarred or even deformed.  In fact cosmetic surgery in the 21st century is generally safe provided its carried out by a reputable surgeon, who takes care and is not too rushed.  Equally important is the qualification of the anaesthetist.   There is a risk of dying under anaesthetic, but this is extremely rare.  Nonetheless, surgery is an invasive procedure and the risks must be taken into account even if they hardly ever occur.  Surgery can cause severe pain, appalling bruising and recovery takes quite a while. 

Scarring is another issue.  The healing of scars and their adding depend not only on the skill of the surgeon but also on the type of operation.       

Again, I am compelled to write that finding the correct surgeon is not easy.  Usually the finest surgeons are the most low- key.  They never advertise and they don’t need to either.  It’s well worth making every effort to find the right surgeon.  Results can never be guaranteed, but you are on the right path if you at least do your homework well I n advance. 

Discuss the kind of face-lift you need. Everybody has different requirements.  Face lifts will not erase superficial wrinkles such as crow’s feet or lipstick-bleed lines around the mouth, and it may have little effect on the nose to mouth grooves or eye area.  However, you might decide you want your chin enhanced or silicone implants in your cheeks.  You may decide to have dermabrasion or laser at the same time.  You could even have lip enhancement or earlobe shortening for example. 

And don’t even consider surgery without going through your complete medical history with your surgeon and if you are a smoker.  Give up smoking at least a month before surgery. And stay off smoking thereafter!!! 

Popular Cosmetic Procedures 

Lifting Face and Neck: 

Facial Rejuvenation rhydectomy or face-lift) 

As we get older skin becomes thinner and less elastic, muscles lose tone and stretching skin is apparent more in the face than anywhere else.  We see deepening grooves from nose to mouth (nasolabial fold), we see jowls and the turkey neck, bags at the corners of the mouth, hooding of upper eyelids and eyes that constantly make us look tired.  The rate at which this occurs varies.  Lifestyle plays a big part.  A nutritious diet, fitness, enough sleep and reasonable levels of stress keep our skin in prime condition.  Genes play a role, but not the largest role by any means.  Heavy smoking, inactivity, excess alcohol, suntanning, suntanning, suntanning, sun…..in our youth, loss of teeth all contribute to our overall facial appearance.  Also we know skin elasticity, broken capillaries, facial shape and colouring affect our rate of ageing.

A rhydectomy (face-lift) diminishes facial wrinkles and lines, tightens loose skin and muscle and freshens facial features.  This is not intended to change the facial structure, but rather the results should be interpreted as a younger look.

If your ace looks tauter when you pull up on the skin in front of your ears, then you might decide to have a face-lift.  The best candidates for this operation are men and women between ages 40-60, with skin still elastic and with strong well defined bone structure. 

Facelifts are being done nowadays more and more on younger people to postpone the signs of ageing rather than trying to turn back the clock.  Another reason for having face-lifts earlier is to retain our looks not wait until the difference in our appearance after surgery is extremely noticeable.  Face lifts can be successful in older people in their seventees’ or even eightees’ but it is preferable to opt for the surgery before age starts to show. 

If you have made a decision to have surgery then remember there is nothing worse than a tight expressionless over-Botoxed, glass or ghost-like laser effect, with high brows that look like you have had an electric shock.  The only thing that compounds this unaesthetic look is an over made face with such heavy base foundation that you need a tractor to scrape it off at night. Obvious dark lip outliner with paler colour lipstick is another no..no..  Subtle is always best and certainly the most sophisticated!  Nothing beats a good natural aesthetic appearance.  

Rhytidectomy surgery and the after effects: 

This operation usually takes between 2-4 hours depending on the complexity. Drains are placed on each side, at the back of the scalp, and left overnight. The next morning the drains are removed, but there is no gentle way to tell you this.  You will look awful.  You will be bruised, swollen with little cuts hidden in your hair.  You will be sore and your face will pull.  You will have to lie propped up on pillows and take painkillers.  Your head will feel like a huge ball on your shoulders. And you in all probability will feel depressed by the third day.  All this subsides and after about two weeks you will look half decent.  Your make up can be applied, probably by day 10. The stitches around the eyes are removed after only a few days and the stitches in the hair are removed too. 

You can wash your hair, but generally the surgeon will advise you to do this standing in a shower. 

Always discuss medication with your doctor as certain painkillers such as asprin and even herbal tintures like arnica can cause bleeding. 

Although you will look fine in round two months, you will be advised to avoid sport or other strenuous activity.  It’s important to keep the skin moisturized.  You will as, has been mentioned several times, feel numbness of cheeks and neck and around the ears.  This can continue for three months. 

What You Can Expect: 

You will look younger but a face lift won’t give you a different ace if you’re unhappy with the one you’ve got.  It won’t restore your youthful vitality either.  It doesn’t stop the clock.  Lines, wrinkles and sagging will continue to develop.   But you will look younger, and feel far better about your appearance if you are realistic and your surgeon complied with your needs.  You will go on ageing and after some years you will be back to where you were – but you will be older.  You will always look better than if you never had the face lift at all.     

Masks:

The idea of having a face lift is that you should look refreshed.  There is nothing more off-putting than a face pulled so tight that it is expressionless.  This tightness leaves you looking totally unnatural.  We see this so often with film-stars. Sometimes it looks like they have thrown all their facial skin over their shoulder and will crack their face in half if they smile. 

Mini Lifts: 

Minilifts’ bring mini results.  Don’t take a shortcut.  Tackling the neck skin alone is usually not successful except for a small area of liposuction.

Smoking: 

This subject has been discussed time and again.  However, for extra measure I will repeat the warning.  Premature ageing was caused y smoking, but if you continue smoking you may probably have healing problems as your circulation will be affected.   Most surgeons won’t operate on smokers at all.

Bleeding: 

There can be a bleed after surgery – you will then need to be returned to the theatre to stop the bleeding and to clan the area and close again.  This should be a relatively minor incident that causes no long-term problems. It should not be a cause for concern

Feeling and Looking Great:   

Allow yourself three months.  The ears and face will pull at different times. There will be numbness for a short while, talking on the phone will feel awkward.  

The ideal age for rhytidectomy:  40-plus years. 

The results last around 7-10 years though effects are semi-permanenet.

Discomfort levels are very high for three weeks.

Risks are numbness which disappears in three to six months, visible scars if poor healing is a problem, and a lift you are not happy with. Nerve damage is very rare. 

Double Chin: 

Removing fat with liposuction is often enough to restore a tight jaw-line to a young person who has developed a double chin.  Older people will however be left with jowls and a turkey neck which looks looser and worse than before if they only have minor liposuction. Usually a face-lift is needed to achieve satisfactory results with ‘turkey necks’. 

Eyelid Surgery-Blepharoplasty and after effects 

Blepharoplasty removes describes an operation that removes excess skin and fat from the upper and lower eyelids.    

The skin invariable grows slack and stretches as we grow older and this manifestation in saggy baggy eyes, both upper and lower lids.  On the upper eyelids excess skin causes the brow to droop.

Surgery involves removing excess skin, lax muscle and to a lesser degree, fat. 

Blepharoplasty Surgery      

The surgery can be performed with local anaesthesia and shouldn’t take more than a maximum of 2 hours.   A hospital stay is unnecessary and patients return home a few hours post surgery.  The surgeon will ensure that no major bleeding has occurred before releasing you, as major bleeding, or bulging during the first 24 hours is considered an emergency and the surgeon must be informed immediately.

Bleeding only occurs in very rarer instances. 

For three days one looks like they have walked into a dozen wooden planks or been hit on the eyes with a brick.  Pain is not unbearable, but pain control medication is usually prescribed and the use of ointments and cold packs. 

Stitching or sutures as plastic surgeons refer to them are removed by day six and make up can be applied from the 10th day. Some people even put on make-up a day or two earlier.  Scars will subside and the subtle change in the appearance of the eyes makes a huge difference to the patient, but should not be obvious to strangers. 

Once again, as with all other surgery, give your surgeon your medical history, particularly if you suffer from a thyroid or bleeding condition, retinal detachment, glaucoma. 

Eyelid surgery is usually performed with a face-lift and so is the eyebrow lift.  It will not eradicate crow’s feet or improve baggy cheeks 

Risks include the taking of either too much or too little skin being removed, making the eyelids too tight to close and sometimes taking too little skin away.

Eyes often water a lot after this type of surgery or feel gritty, itchy and swollen.  There is also loss of sensation in the lids, but this is temporary lasting up to 6 weeks 

This surgery is generally extremely safe. Seek a competent surgeon who has had a great deal of experience in this area.  Risks include inability to close eyes causing dry eyes, and too much skin removed producing rounder eyes and more white of the eye showing. 

Sculpting Your Nose (Rhinoplasty) 

This is one of the most common plastic surgery procedures.   It is important to know that a large bulbous nose can’t be transformed into a pert chiseled one, but it can be reduced or go up a size or two.  Humps, tips and nostrils can all be adjusted. 

As we grow older there is a distinct drooping of the tip of the nose because of thinned skin and the result is a broader or more bulging nose.  The tip can be tilted to create a more youthful appearance.  When one is younger they may want to alter the appearance of a malformed or distinctly ethnic nose.  It’s important not to have a dogmatic preconceived idea about the type of nose you want, as the shape you think is perfect might not suit the shape of your face.  Again, an experienced surgeon will work through the procedures and discuss results and the best type of nose for your face. Listen to your surgeon who wants to do less, rather than more and who takes cognizance of your face shape and advises you against having your nose changed to imitate a picture you have produced from a magazine. 

The nose you end up with should depend a great deal on the jaw and even body shape.  

Rhinoplasty Surgery and its effects: 

There are several types of rhinoplasty but generally the surgeon breaks the nose and then pushes both sides in. 

A large risk is if too much tip is not in proportion and too much cartilage is removed. This leaves one with an unnatural appearance.

Nowadays thankfully this type of surgery has become more conservative.  The clone-like ‘ski-jump obvious appearance of the past resulted in cosmetic failures, and too often cases where patients have functional problems with breathing. 

After surgery a plaster cast or splint is taped over the nose to hold the fractured bones steadily in place.  This operation involves very little discomfort.  External stitching is taken out within four days and the plaster removed approximately 8-10 days post surgery.

Breathing may have to take place through the mouth and it can take months before all the swelling is reduced.  The sun must be protected specially from being knocked or the sun and heat. 

Although the nose remains numb for a few months, most people are absolutely thrilled with their new nose.  Have patience.  Results may take about six months to really kick in. 

Round one in 20 people who have a nose-job may want touch-up surgery because they feel it is not technically perfect.

One can have a temporarily runny nose, and very rarely a permanent breathing obstruction. 

Generally the patient spends a night in hospital.      

Breast Surgery: 

Too big, too small, too droopy, badly shaped; these are all problems that plague women.

Changing one’s breasts has become very fashionable. Be wary of changing fashions though.  Many women follow fashion magazines and after having had Dolly Parton breast implants decide later pert breasts are more flattering and then they opt for reduction.  

Breasts positively change with age and child bearing unless we are extremely fortunate. The following are procedures that improve our breasts.  Breast remodeling – mammoplasty – can reduce, augment, lift or reshape the breasts. 

Augmentation:

If your breasts shrunk to nothingness with breastfeeding or you have always been unhappy with their size then augmentation is the right operation for you. 

Breast augmentation describes the procedure that increases the size and volume of the breasts using artificial implants or prosthesis. The prosthesis may be made of silicone gel, saline or filler.  There are several methods of performing this surgery.

There are also a growing number of women who receive implants for reconstructive surgery following mastectomy due to cancer. 

Safety of Silicone Implants: 

In the early nineties there was a silicone scare with claims ranging from silicone causing disorders ranging from breast cancer and rheumatoid arthritis to ME (chronic fatigue syndrome).  Silicone implants have finally been given the all-clear in exhaustive tests carried out both in the Untied Kingdom and the USA.  The UK Department of Health has given silicone the clean bill of health and these are the most commonly used implants and the most natural feeling implants.  Once they have been fitted the patient should be completely unaware of their existence. 

There are various ways of performing this surgery ranging from inserting the implants under the armpits the bellybutton or through a small incision under the breasts.  The placement of the implant and incision is extremely important – if placed too high it can look obvious and change the appearance of the breast.  Most surgeons cut a little higher that the breast crease ensuring the scar does not protrude when you lie on your back in a bikini. 

Augmentation surgery and the effect: 

The external scar is small but the internal scar is large and when waking from the anesthetic it is extremely painful, more so if the implants are placed behind the chest muscle, which bruises.  The pain will last for up to six days with stitching and dressings removed after ten days. 

For ten days you must not drive at all and you should only begin exercising three weeks after the operation.  Violent movements and stretching is inadvisable for at least six weeks.  Washing hair can be a problem so get assistance.

As mentioned with other surgery avoid asprin for two weeks before surgery and stop smoking to avoid anesthesia complications.  

Complications are rare, but they include infection and accumulations of clotted blood (haematoma). 

At first the implants will feel quite hard but any pain with a change of shape in the breast must be investigated in the unlikely event that the implant has ruptured. 

Risks include loss of symmetry and formation of capsule, though this is not generally the case at all; another problem can be loss of sensation of the nipples.  The results from the augmentation are permanent. 

Bee-sting Mouth: Lip Enlargement 

Thanks to Hollywood there is a fashion at this time for large lips.  This would have been considered extremely unsightly years ago – and may prove to be unfashionable in the near future. 

Even maintaining our ‘normal’ lips shape is difficult if not impossible as we age because lip narrowing and lengthening (thin lips) is a feature of ageing.  

There is no totally foolproof way of augmenting our lips.  Silicone in lips must be avoided, so most people opt for collagen or restylane injections’ which is carried out in the actual lips as well as the upper rim of the lip to enhance the cupids bow. 

Collagen doesn’t last long due to rapid absorption resulting in monthly top-ups.  This requires very deep pockets! 

Sometimes fat is injected but this too disappears. 

Surgical Lip Augmentation and Its Effect: 

This is done with a fat graft from the abdomen or buttocks, which is slid into a tunnel hollowed out of the top lip. 

This leaves a scar where the graft was taken, unless a pre-existing scar is opened again. The lips can become injected and the graft may need to be removed. IF it is successful, it’s the finest way of augmenting the lips. 

To thin overlarge or fleshy lips the reverse procedure is performed.  A strip of fat is cut from the inside of the lips, so they roll neatly inwards.   This type of operation is generally sought by black people. 

It will take two to six weeks to heal, the length of time the results last is variable and you can expect discomfit, particularly if infection sets in.    

Breast Reduction:      

The aim of breast reduction is to create a natural shape as large breasts attract a lot of unwanted attention which can cause a woman to become extremely self-conscious.  Large breasted women are often the butt of men’s jokes and the reduction of breast size has huge psychological benefits as well as relieving the physical discomfir arising from large breasts.  

This operation results in reduced breast size, reshaped breasts and the nipple and areola complex moved up to a new position with skin excess rmoved.  Various techniques are used. 

Before undertaking a breast reduction it is important that your weight is within five kilograms of ideal weight.  Large weight gain or loss following surgery can undoubtedly affect the aesthetic results. 

Recovery takes a few weeks but as with augmentation one can resume driving 10 days post operatively.  Small areas of delayed healing sometimes occur over the first few weeks and treating the area with topical ointment will do the trick. The cause of this ‘weeping’ is fragments of dissolving stitches emitted particularly where skin closes tightly.

Risks are rare.  If any occur they would be blood clots. Within twelve weeks signs of surgery have disappeared and the results are permanent. 

Surgical Lifting Of The Breasts: (Mastopexy or Ptosis Correction) 

Breasts tend to droop after pregnancy, weight reduction and with ageing.

Mastopexy can be done with or without implants and this is a day procedure if implants are not inserted.  Often breasts are lifted and the implants added at a later date. 

Risks rarely if ever occur, and if they do, they will be the same type of risks as for breast reduction. They occur even far less than with breast reduction.

The ideal age for this surgery is 40-plus.  Results are good but breasts will continue to droop with age due to an excess of skin, lax skin with poor elasticity. 

Breast Reconstruction Following Mastectomy: 

Breast cancer in these times is vastly different to that in days of yore. Fewer women have to suffer the mutilation of a complete mastectomy (breast removal).  Often lumpectomy is performed (removal of the lump, and more often than not, lymph nodes in the armpit), followed by chemotherapy or radiotherapy 

Virtually everybody can have a reconstruction following a mastectomy; sometimes it is done at the same time as the removal. 

There are a variety of ways in which to reconstruct the breasts depending on the type of mastectomy and whether a woman has radiotherapy or not. Radiotherapy has an effect on the skin healing. This operation takes a few hours and recovery several weeks. 

Nipple reconstruction generally follows a few months later. 

This surgery is painful.  The risks are asymmetry or skin flap failure if flap reconstruction (an alternative to implants) is performed. 

Suction Assisted Lipectomy Liposuction Surgery: 

Liposuction has been performed on almost every part of the body and is among the commonest of all plastic surgery procedures performed.  *According to the American Association for Aesthetic Plastic Surgery there is an increase of 118% in this type of surgery since 1997.  The operation keeps increasing in popularity. 

The Surgery and Its Effect: 

This is not an answer to weight loss which can be achieved by following a sensible diet. It is the method of removing fatty tissue by sucking it out through a metal cannula (tube.)  There are various methods of performing this operation and it can be under general anesthesia, as an in-patient or out-patient, depending on the amount of suction needed. 

The idea is to remove stubborn deposits of fat safely, to contour areas with aesthetically pleasing results and to minimize associated deformities. Liposuction is ideal for love handles and saddlebag thighs. 

Liposuction is contra-indicated for cellulite problems. If anything it aggravates them. 

Large volumes of liposuction are dangerous as any competent and experienced plastic surgeon is aware. It is even more dangerous if performed on an out-patient basis.  There are fluid changes in the body. 

Liposuction is used:

Benath the chin, as part of a face-lift

On the upper arms (which is not always successful)

On the breasts, as part of breast reduction

On the abdomen, as part of a tummy tuck

On the lower back, where skin is too thick (for liposuction to work well)

On the lower part of the abdomen, where it is successful if skin is thick

On the hips, where it is extremely beneficial

On the buttocks

On the outer thigh, where good results are achieved

On the inner thigh, (results are poor as skin is thin)

Above the knee

On the inner part of the knee 

Risks are as mentioned above.  This is surgery and it needs a competent surgeon. However, patients are generally extremely satisfied with the results.  One won’t lose weight from liposuction as mentioned above.  There will be post-operative swelling and sometimes, but rarely a blood transfusion is required.  For this reason too much fat should not be removed at one time. 

It can take from six weeks to six months for all signs of surgery to disappear completely depending on the type of liposuction performed. Tight garments are worn after surgery.  Patients can drive after 10 days.

Liposuction shouldn’t really be performed after the age of 55 years.  And, this is one time when men get a raw deal. It may be more acceptable for men to have a protruding tummy, but it is not as easy for men to rid themselves of the fat deposit.  Fat distribution in the male is different to that in a female.  Male liposuction works better on hip and back rolls. 

Tummy Tuck Surgery (Abdominoplasty)    

After having the second child it is almost unheard of for a woman to find her stomach to look as it did before childbirth.  Aside from stretch marks the lower abdomen develops a roll which is evident in slacks, bathing costume or skirts.

Sometimes a tummy tuck is necessary after major weight loss.  Then excess skin must be removed and lax muscles tightened.  This operation must be performed when the patients weight is ideal, and certainly after childbirth and if one is willing to have a scar.

A Tummy tuck is not the same thing as liposuction.  Liposuction does not remove loose skin or tighten a tummy.  For a flat, tight tummy abdominoplasty is for you. 

Abdominoplasty Surgery and Its Effect: 

Surgery can take anything up to 2 hours.  You will have to stay overnight in hospital and be restricted from sitting upright for 10 days after which time driving can commence.  

It takes up to two months for swelling to subside and for feeling to return.  Occasionally a small area centre of the cut may remain numb. 

The scar extends from hip to hip horizontally in the same position as a Caesar Section Scar but this scar is longer.  It can be performed low enough to be covered by a bikini swimsuit.

Complications can arise from blood clots or circulatory failure, but this can be avoided, and the operation is generally extremely successful.  

Flabby Arms 

You can consider your arms flabby if they wobble no matter how well-toned your triceps – the muscles at the back of the upper arm.  Excess skin and fat gathers in this area over the age of 30 and more so for women who have gained and lost weight repeatedly causing the skin to lose its elasticity. 

Arm reduction leaves a visible scar and most surgeons would advise against arm reduction unless it is an extreme situation. Liposuction is not advised for flabby arms because it may leave an empty bag of skin that looks far worse than the initial flabbiness. 

Genital Surgery 

This surgery is growing in popularity. Technically this is a simple operation for a competent plastic surgeon.  However  it shouldn’t ever be performed if the patient hasn’t a valid reason for concern.  It is extremely common for a reliable surgeon to refer the patient to a sex therapist or a psychologist in case her fears are ill founded.

Comments’ made by a hurtful partner is certainly no cause for this type of operation. 

That being said these are the common procedures: 

Genital Reduction Surgery and Its Effect: 

Surgery for enlarged, oversized and stretched vaginas is generally required due to enlargement occurring in childbirth.  Older, post-menopausal women also sometimes find their vaginas enlarged and of course a woman who has been treated for cervical cancer may need vaginal reconstruction.

You will first need an internal examination and as with all surgery give a full medical history. 

This operation is performed under a general anesthetic and involved an overnight stay in hospital.  A wedge shaped section of the vaginal wall is removed (usually due to stretching or tearing).  Muscle and skin re rejoined with stitches. 

It can be very painful but the area heals well and within ten days there shouldn’t be any discomfit. 

It will take a while longer before penetrative sex is comfortable, as sometimes the surgeon may over-tighten the vagina, but this problem resovles itself.

There are no risks with this surgery. 

Labial Surgery and Its Effect:    

This type of surgery is requested by women who find their labia large or cauliflower shaped and it protrudes beyond the outer lips of the vagina causing discomfit and rubbing against clothing or during sex. 

This too will be performed only if a reliable plastic surgeon finds a form of deformity as unkind partners can cause a great deal of insecurity with hurtful comments. 

The operation is simple and carried out either under local or general anesthetic.  Many surgeons suggest an epidural block.  There can be no complications anticipated but as it is a sensitive spot healing must take place to avoid painful sex. 

Teeth 

Crooked chipped crowded or dirty looking teeth are a far more unappealing sight than a few wrinkles.  Cosmetic dentistry is a growing industry.  As we age we may not require treatment for dental decay but the appearance of our teeth deteriorates. They become brittle and tend to go yellow.  They may chip or fracture or wear down.   Creeping gum disease from a build-up of plaque affects us as we get older. 

We have already discussed flossing and caring for teeth as well as teeth whitening but dental contouring crowns veneers and gum contouring are now all options.  

Men’s Plastic Surgery 

Men’s plastic surgery has come of age.  Apart from the most common complaint of male balding many men are now honest about having corrective surgery.  However, in many cases, unlike females, warning bells should ring in some cases when narcissistic men insist on having corrective surgery.  If a client presents with severe psychological obsessions a surgeon should be able to pick it up after careful questioning during the first consultation.  Take the example of the forehead. Forehead creases can be attractive on a man as can frown-lines. They may contribute towards his masculine appeal.  Therefore botoxing a male forehead seems inappropriate.  

Breast Reduction Surgery and Its Effect 

Many men are self-conscious about protruding breasts that no amount of dieting will correct.  The condition is sometimes caused by weight lifers who take steroids as well as with overweight.  This cause of psychological distress can be eliminated with sugery.  It is becoming an increasingly popular operation. 

If the breasts only consist of fat then liposuction is a great option. 

Pectoral Augmentation:  Its’ Effect 

Pectoral implants are popular with bodybuilders.  Incisions are made under the armpit, whre hair conceals the scar.

Generally this is a straightforward operation but it requires an anesthetic and excess fluid may need to be drained off.  Therefore the surgeon shouldn’t remove the drains too soon.  Infection occasionally arises, but the results are permanent. 

Tummy Tuck: Its’ Effect  

Men tend to accumulate diet resistant fat in their lower back, tummy and breasts with ageing.  The bulging tummy is often from intra-abdominal fat.  This type of body contouring in males usually means removal of skin the entire width of the waist.

The results are good and most men aren’t even self conscious about scars. 

Penile, Buttocks and Bicep Implants and Their Effect 

These forms of surgery are subject to infection, disfiguring and tissue hardening.  The patient should have extremely valid reasons for having any of these types of operations.

With calf augmentation silicone implants plump out narrow calves.  It’s a relatively simple operation but it takes a while before the implants settle and the legs will be swollen and painful for a few days.  It can take up to eight weeks before the legs feel comfortable. 

Penis Augmentation is rarely successful.  Most men feel their penises are not big enough.  They equate manhood with a large penis.  Very rarely is a man’s penis too under endowed. A micropenis (small penis) is rare – and results from a shortage of the male hormone, testosterone. 

Men generally worry more about their penis in a natural state than when it is erect.  The operation is risky and painful. 

Sometimes a man will consult a surgeon about increasing the width of his penis rather than extending the length.  In this case fat is injected into the penis – liposuctioned out of the man’s abdomen wall.  The surgery is painful and the risks include infection and scarring, impotence and deformity. 

Hair Transplants: 

Unless you are Bruce Willis, most men feel psychologically distressed at hair loss.  Thinning hair even prevents some men from normal functioning at their best. 

Balding is mostly a genetic factor, and interestingly it is genetically determined from the female line (our mothers father).

If a man has a full head of hair at 45, he is likely to stay that way. 

Women with thinning hair are even more complexed than men. Female hair loss is caused by an excess of androgen (testosterone) due to stress.  A while backthere was a study in the USA showing a huge increase in female hair thinning and baldness as more and more women were in high power positions in the workforce.  This was due to an increase in testosterone from stress.  However menopause definitely plays a role in thinking hair due to decreased oestrogen.

Auto-immune diseases also play a role in balding. 

Hair transplants in women are not successful and medications such as Minoxidil (Regaine/Rogaine) that have been widely used for 10 years are short lived. Three months after stopping medication the head looks exactly as before beginning treatment.  

Hair transplants have made great strides.  The most modern hair transplants do not resemble the artificial looking replacements of yesteryear.   Nowadays microfollicle grafting, tiny hair grafts are blended throughout the balding area creating hairlines that are indistinguishable from natural hairlines. 

Reputable plastic surgeons specializing in this treatment will tell a patient that their attitude towards hair restoration should resemble that of a hairpiece – if obvious, inviting attention, go bald gracefully.  Ill fitting hairpieces and poorly performed hair restoration surgery must be avoided. What more its unnecessary with the advent of microfollicle hair transplant surgery. 

Hair Transplant Surgery and Its Effect:

This procedure is performed under local anaesthesia on an outpatient basis. The procedure takes between 3-5 hours and on the third day after surgery there may be significant swelling.  This will abate completely within five days. Results begin to show at round three months post surgery and normally more than 95% of grafted hair follicles take successfully.

There are few experts in hair transplants, particularly in South Africa and homework on your surgeon is vital. 

Popular magazines tout the fantastic results from Laser Therapy for balding.  There is absolutely no concrete evidence – other than misleading advertisement photos – that this is successful.  It is not advised and can be a financially costly exercise with disappointing results. 

Things to take into account when having plastic surgery: 

In ‘A Cut Above the Rest’, Professor Alan Widgerow takes into account post operative procedures that need to be taken into account as well as advice before and following surgery that  he rates almost as important as the efficacy of the surgery itself. 

Scars:

It is imperative that your plastic surgeon manages the patient’s scars.  If the doctor does not include this as an integral part of the procedure – then the client is not being adequately treated.  Particularly important is the history of the patient and the need to identify whether the patient has a history of keloid formation. 

Complications

A surgeon who claims to get no complications ever is not operating enough.  Complications are a fact of life.  Minor complications include stitch reactions, small bleeds, minor infections, excessive swelling.

The surgeon who prides himself in being the fastest in town is not for you.  A surgeon who has a reputation for complications of significant bleeds in many clients must be avoided.  Speedy and efficient is one thing, but rushing through surgery to get it over with is not an option. 

Swelling

If you call your surgeon, day or night regarding swelling, bruising or one side much larger than the opposite side and you are told to take a pain tablet and report back in a few days, don’t accept it.  A complaint like this needs immediate attention if it’s the day of surgery, or the next morning if it occurs days or weeks after surgery. 

Blood Thinners

Your surgeon should routinely take a medical history and advise against asprin and some homeopathic medications before surgery. Be sure to list every single medication that you take. 

Nerve Weakness 

A surgeon who accepts temporary facial nerve weakness in more than 5% of clients (as some do) is using a technique which is too risky.  If the surgeon claims the procedure produces better long term results but is more complicated, longer, with a higher incidence of temporary facial nerve weakness don’t accept it.  A permanent facial nerve injury is never worth it, or an acceptable part of any procedure. 

Liposuction Errors

Liposuction resulting in areas of skin loss, injury to bowel or major nerves or gross irregularities and indentations is unacceptable. 

Experiments

Don’t be a guinea pig with new procedures 

Nipple Loss 

Surgeons who accept nipple loss as part of breast reduction procedure, loss of feeling in the nipple as a common occurrence with augmentation, lower eyelids pulled down abnormally after eyelid surgery, brows high in mid forehead after brow lifts, marked asymmetry between two breasts or sides of the face or eyes are accepting the unacceptable in the normal routine of cosmetic surgery. 

Permanent Scarring following Resurfacing Procedures 

Scarring from dermabrasion, chemical peel or resurfacing procedure shouldn’t occur.  The area for surgery has been poorly selected or the procedure too deeply performed (unless the scarring follows severe allergy or infection impossible to anticipate) 

Nasal Breathing

Nasal breathing problems or nasal collapse should not occur after rhinoplasty (nose job)

Complications Related To Smoking

This is jointly the fault of patient and surgeon.  The surgeon should not accept the case of a heavy smoker.   Smoking causes patients circulatory problems in face-lifts and tummy tucks. 

Finally, most vital consideration of all be discerning and educated when you make an assessment of the surgeons prowess. 

HOW TO CHOOSE A SURGEON

Ensure that your surgeon is a member of the SA Plastic Surgeons Association

Find out how much experience he/she has had

Find out how many similar procedures to yours he/she has performed; many doctors are specialists in certain procedures and others cover a wide range.

Word of mouth from satisfied patients is always worth considering

Be explicit about what you want change.   Be precise

Ask about the risks and what can be achieved realistically

Find out the exact price of your surgery, plus hospitalization and anesthetic

Ask how to prepare yourself fro surgery and what type of anesthetic you will be having

Ask how long you can expect to be in pain, bruised and about scar healing and recovery time.

Ask how long the results will last

Ensure that the doctor you consult will be performing the operation from start to finish

It’s often wise to consult two or three cosmetic surgeons before you make the final decision as to whom you wish to do your procedure

Listen to the doctor. If two or three doctors tell you that surgery is unnecessary take their advice

* Excerpts from ‘A Cut Above The Rest’*

 

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