By: Kim Pham & Whitney Edwards

What is Plastic Surgery?

Plastic surgery is a general term for operative manual and instrumental treatment which is performed for functional or aesthetic reasons. The word "plastic" derives from the Greek plastikos meaning to mold or to shape; its use here is not connected with modern plastics.

Two Different Types of Plastic Surgery

There are two broad fields of Plastic Surgery

• Reconstructive• Cosmetic

Reconstructive Surgery

• Focuses on undoing or masking the destructive effects on trauma, surgery, or disease. Reconstructive surgery may include closing defects using sink grafts.

• It is estimated that more than 1 million procedures are performed by plastic surgeons every year.

Who Has Reconstructive Surgery?

• Two basic categories

Congenital Deformities - known as birth defects. Examples: birthmarks, cleft-lip, webbed fingers.

Those who develop deformities from accidents, infection, disease, or sometimes aging Examples: Burn wounds, lacerations, growths, and aging problems are considered acquired deformities

Reconstructive Surgery

• The most common reconstructive surgeries would be:

• Breast Reduction• Cleft lip and palate surgery

• Contracture for burn survivors• Closing skin after removal of tumors in head and

neck region• Sex reassignment surgery for transsexual

people

Cosmetic Surgery

Is most often performed in order to change features the patient finds unflattering. In many cases, however, there are medical reasons. Ex: breast reduction when orthopedic problems are present.

Cosmetic Surgery Statistics

• In the U.S. Alone in 2004 11.9 million cosmetic procedures were performed.

• More than 10 million cosmetic procedures were performed in 2005, a 38% increase since 2000.

• There are 5000 members on the board-certified plastic surgeons in the world, 94% is found in the U.S.

Cosmetic Surgery

Critics of plastic surgery note that it is legal for any doctor, regardless of specialty, to perform "cosmetic surgery", but not "plastic surgery". It is thus important to distinguish the terms "plastic surgery" and "cosmetic surgery“ Plastic Surgery is recognized by the American Board of Medical Specialties as the subspecialty dedicated to the surgical repair of defects of form or function. The term "cosmetic surgery" however, simply refers to surgery that is designed to improve cosmetics, or appearance. Thus there is no real art of "cosmetic surgery“. Doctors are not allowed to use the term "plastic surgery".

Most Common Cosmetic Procedures

Females• Breast

Augmentation• Breast implant

removal• Breast Lift• Butt lift• Botox• Cellulite Treatment

Males• Breast Reduction• Chin Augmentation• Hair Transplant• Otoplasty (Ear) • Laser Hair removal• Microdermabrasion

Procedures• ABDOMINOPLASTY

(Tummy Tuck)Procedure:Flatten abdomen by removing excess fat and skin and tightening muscles of abdominal wall.Length:2 to 5 hours.Anesthesia:General, or local with sedation.In/Outpatient:Either depending on individual circumstances and extent of surgery.Side Effects:Temporary pain. Swelling, soreness, numbness of abdominal skin, bruising, tiredness for several weeks or months.Risks:Blood clots. Infection. Bleeding under the skin flap. Poor healing resulting in conspicuous scarring or skin loss. Need for a second operation.Recovery:Back to work: 2 to 4 weeks. More strenuous activity: 4 to 6 weeks or more. Fading and flattening of scars: 3 months to 2 years.

Procedures• BREAST ENLARGEMENT 

(Augmentation Mammaplasty)• Procedure:Enhance the size of breasts using inflatable implants filled with

saline.• Length:1 to 2 hours.• Anesthesia:Local with sedation, or general.• In/Outpatient:Usually outpatient.• Side Effects:Temporary soreness, swelling, change in nipple sensation,

bruising. Breast sensitive to stimulation for a few weeks.• Risks:Lack of implant permanence -- surgical removal or replacement of

the implants may be required to treat problems, including: deflation; the formation of scar tissue around the implant (capsular contracture), which may cause the breast to feel tight or hard; bleeding or infection. Increase or decrease in sensitivity of nipples or breast skin, occasionally permanent. Mammography requires a special technique. (Note: Some women have reported symptoms similar to those of immune disorders. Ask your doctor about these and other FDA concerns.)

• Recovery:Back to work: a few days. Physical contact with breasts: 3 to 4 weeks. Fading of scars: several months to a year or more.

• Duration of Results:Variable. Implants may require removal or replacement.

Procedures• BREAST LIFT

(Mastopexy)• Procedure:Raise and reshape sagging breasts by removing

excess skin and repositioning remaining tissue and nipples.• Length:1 to 3 hours.• Anesthesia:Local with sedation, or general.• In/Outpatient:Usually outpatient. Sometimes inpatient.• Side Effects:Temporary bruising, swelling, discomfort,

numbness, dry breast skin. Permanent scars.• Risks:Thick, wide scars; skin loss; infection. Unevenly

positioned nipples. Permanent loss of feeling in nipples or breast.

• Recovery: Back to work: 1 week or more. Strenuous activities: 1 month. Fading of scars: several months to a year.

• Duration of Results:Variable; gravity, pregnancy, aging, and weight changes may cause new sagging. Results may last longer or be enhanced when breast implants are inserted as part of the procedure.

Procedures• COLLAGEN / FAT INJECTIONS• Procedure:Plump up creased, furrowed, or sunken facial

skin; add fullness to lips and backs of hands. Works best on thin, dry, light-colored skin.

• Length:15 minutes to 1 hour per session.• Anesthesia:Collagen: usually none; local may be included

with the injection. Fat: local.• In/Outpatient:Outpatient.• Side Effects:Temporary stinging, throbbing, or burning

sensation. Faint redness, swelling, excess fullness.• Risks:Collagen: allergic reaction including rash, hives,

swelling, or flu-like symptoms; possible triggering of connective-tissue or autoimmune diseases. (A skin test is required before collagen treatment to determine whether an allergy exists.) Both: Contour irregularities, infection.

• Duration of Results:Variable; a few months to 1 year.

Procedures• DERMABRASION• Procedure:Mechanical scraping of the top layers of skin using a high-speed

rotary wheel. Softens sharp edges of surface irregularities, including acne and other scars and fine wrinkles, especially around the mouth.

• Length:A few minutes to 1 hour. May require more than 1 session.• Anesthesia:Local, numbing spray, or general.• In/Outpatient:Usually outpatient.• Side Effects:Temporary tingling, burning, itching, swelling, redness.

Lightening of treated skin. Acute sensitivity to sun; loss of ability to make pigment (tan).

• Risks:Abnormal color changes (permanent). Tiny whiteheads (temporary); infection; scarring; flare-up of skin allergies, fever blisters, cold sores.

• Recovery:Back to work: 2 weeks. More strenuous activities: 4 to 6 weeks. Fading of redness: about 3 months. Return of pigmentation/sun exposure: 6 to 12 months.

• Duration of Results:Permanent, although new wrinkles may form as skin ages.

Procedures• EAR SURGERY

(Otoplasty)• Procedure:Set prominent ears back closer to the head, or reduce the size

of large ears. Most often done on children between the ages of 4 and 14 years. (Occasionally covered by insurance.)

• Length:2 to 3 hours.• Anesthesia:Young children: usually general. Older children or adults:

general or local, with sedation.• In/Outpatient:Usually outpatient.• Side Effects:Temporary throbbing, aching, swelling, redness, numbness.• Risks:Infection of cartilage. Excessive scarring. Blood clot that may need to

be drained. Mismatched or artificial- looking ears. Recurrence of the protrusion, requiring repeat surgery.

• Recovery:Back to work or school: 5 to 7 days.Strenuous activity, contact sports: 1 to 2 months.

• Duration of Results:Usually permanent.

Procedures• EYELID SURGERY

    (Blepharoplasty)• Procedure:Correct drooping upper eyelids and puffy bags below the eyes by

removing excess fat, skin, and muscle. (Upper-eyelid surgery may be covered by insurance if used to correct visual field defects)

• Length:1 to 3 hours.• Anesthesia:Usually locally with sedation or general.• In/Outpatient:Usually outpatient.• Side Effects:Temporary discomfort, tightness of lids, swelling, bruising.

Temporary dryness, burning, itching of eyes. Excessive tearing, sensitivity to light for first few weeks.

• Risks:Temporary blurred or double vision. Infection, bleeding. Swelling at the corners of the eyelids. Dry eyes. Formation of whiteheads. Slight asymmetry in healing or scarring. Difficulty in closing eyes completely (rarely permanent). Pulling down of the lower lids (may require further surgery). Blindness (extremely rare).

• Recovery:Reading: 2 or 3 days. Back to work: 7 to 10 days. Contact lenses: two weeks or more. Strenuous activities, alcohol: about 3 weeks. Bruising and swelling gone: several weeks.

• Duration of Results:Several years. Sometimes permanent.

Procedure• FACELIFT

    (Rhytidectomy)• Procedure:Improving sagging facial skin, jowls, and loose neck skin by

removing excess fat, tightening muscles, redraping skin. Most often done on men and women over 40.

• Length:Several hours.• Anesthesia:Local with sedation, or general.• In/Outpatient:Usually outpatient. Some patients may require short inpatient

stay.• Side Effects:Temporary bruising, swelling, numbness and tenderness of

skin; tight feeling, dry skin. For men, permanent need to shave behind ears, where beard-growing skin is repositioned.

• Risks: Injury to the nerves that control facial muscles or feeling (usually temporary but may be permanent). Infection, bleeding. Poor healing; excessive scarring. Asymmetry or change in hairline.

• Recovery:Back to work: 10 to 14 days. More strenuous activity: 2 weeks or more. Bruising: 2 to 3 weeks. Must limit exposure to sun for several months.

• Duration of Results:Usually 5 to 10 years.

Procedures• FACIAL IMPLANTS• Procedure:Change the basic shape and balance of the face using carefully

shaped implants to build up a receding chin, add prominence to cheekbones, or reshape the jawline.

• Length:30 minutes to 2 hours.• Anesthesia:Local with sedation, or general.• In/Outpatient:Usually outpatient. Occasionally overnight hospital stay.• Side Effects:Temporary discomfort, swelling, bruising, numbness and/or

stiffness. In jaw surgery, inability to open mouth fully for several weeks.• Risks:Shifting or imprecise positioning of implant, or infection around it,

requiring a second operation or removal. Excess tightening and hardening of scar tissue around an artificial implant ("capsular contracture"), causing unnatural shape.

• Recovery:Back to work: about 1 week. Normal appearance: 2 to 4 weeks. Activity that could jar or bump face: 6 weeks or more.

• Duration of Results:Permanent.

Procedures• FOREHEAD LIFT

(Browlift)• Procedure:Minimize forehead creases, drooping eyebrows, hooding over

eyes, furrowed forehead and frown lines by removing excess tissue, altering muscles and tightening the forehead skin. May be done using the traditional technique, with an incision across the top of the head just behind the hairline; or with the use of an endoscope, which requires 3 to 5 short incisions. Most often done on people over 40.

• Length:1 to 2 hours.• Anesthesia:Local with sedation, or general.• In/Outpatient:Usually outpatient.• Side Effects:Temporary swelling, numbness, headaches, bruising.

Traditional method: Possible itching and hair loss.• Risks:Injury to facial nerve, causing loss of motion, muscle weakness, or

asymmetrical look. Infection. Broad or excessive scarring.• Recovery: Back to work: 7 to 10 days, usually sooner for endoscopic

forehead lift. More strenuous activity: several weeks. Full recovery from bruising: 2 to 3 weeks. Limit sun exposure for several months.

• Duration of Results:Usually 5 to 10 years.

Procedures• HAIR REPLACEMENT SURGERY• Procedure:Fill in balding areas with a patient's own hair using a

variety of techniques including scalp reduction, tissue expansion, strip grafts, scalp flaps, or clusters of punch grafts (plugs, miniplugs and microplugs). Works best on men with male pattern baldness after hair loss has stopped.

• Length:1 to 3 hours. Some techniques may require multiple procedures over 18 months or more.

• Anesthesia:Usually local with sedation. Flaps and tissue expansion may be done with general anesthesia.

• In/Outpatient:Usually outpatient.• Side Effects:Temporary achy, tight scalp. Unnatural look in early

stages.• Risks:Unnatural look. Infection. Excessive scarring. Failure to

"take." Loss of scalp tissue and/or transplanted hair.• Recovery:Back to work: usually 2 to 5 days. More strenuous

activities: 10 days to 3 weeks. Final look: may be 18 months or more, depending on procedure.

• Duration of Results:Permanent.

Procedures• LASER FACIAL RESURFACING• Procedure:Smooth the face and smooth fine wrinkles using a carbon

dioxide (CO2) laser device that treats layers of damaged skin. Softens lines around the eyes and mouth and minimizes facial scars and unevenly pigmented areas.

• Length: A few minutes to 1 hour. May require more than 1 session.• Anesthesia:Local with sedation, or general.• In/Outpatient:Usually outpatient, unless combined with other surgical

procedures that require hospitalization.• Side Effects:Temporary swelling, discomfort. Lightening of treated skin.

Acute sun sensitivity. Increased sensitivity to makeup. Pinkness or redness in skin that may persist for up to 6 months.

• Risks:Burns or injuries caused by laser heat. Scarring. Abnormal changes in skin color. Flare-up of viral infections ("cold sores") and other infections (rare).

• Recovery:Back to work: 2 weeks. More strenuous activities: 4-6 weeks. Complete fading of redness: 6 months or less. Return of pigmentation/light sun exposure: 6-12

• Duration of Results:Long-lasting, but does not stop aging. New wrinkles, expression lines may form as skin ages.

Procedures• LIPOSUCTION

(Suction-Assisted Lipectomy)• Procedure:Improve body shape by removing exercise-resistant fat deposits with a tube

and vacuum device. Can be performed using the tumescent technique, in which targeted fat cells are infused with saline containing solution with a local anesthetic before liposuction to reduce post-operative bruising and swelling. Common locations for liposuction include chin, cheeks, neck, upper arms, above breasts, abdomen, buttocks, hips, thighs, knees, calves, ankles.Length:1 to 2 hours or more. UAL: 20-40 percent longer than traditional liposuction.

• Anesthesia:Local, epidural, or general.• In/Outpatient:Usually outpatient. Extensive procedures may require short inpatient

stay.• Side Effects:Temporary bruising, swelling, numbness, soreness, burning sensation.

Tumescent: Temporary fluid drainage from incision sites. UAL: Larger incisions for cannula.

• Risks:Asymmetry. Rippling or bagginess of skin. Pigmentation changes. Skin injury. Fluid retention. Excessive fluid loss leading to shock. Infection. UAL: thermal burn injury caused by the heat from the ultrasound device.

• Recovery:Back to work: 1 to 2 weeks. More strenuous activity: 2 to 4 weeks. Full recovery from swelling and bruising: 1 to 6 months or more. Use of tumescent technique or UAL may decrease post-operative bruising and swelling.

• Duration of Results:Permanent, with sensible diet and exercise.

Procedures• MALE BREAST REDUCTION

(Gynecomastia)• Procedure:Reduce enlarged, female-like breast in men using liposuction

and/or cutting out excess glandular tissue. (Sometimes covered by medical insurance.)

• Length:1 hour or more.• Anesthesia:General or local.• In/Outpatient:Usually outpatient.• Side Effects:Temporary bruising, swelling, numbness, soreness, burning

sensation.• Risks:Infection. Fluid accumulation. Injury to the skin. Rippling or bagginess

of skin. Asymmetry. Pigmentation changes (may become permanent if exposed to sun). Excessive scarring if tissue was cut away. Need for second procedure to remove additional tissue.

• Recovery:Back to work: 3 to 7 days. More strenuous activity: 2 to 3 weeks. Swelling and bruising: 3 to 6 months.

• Duration of Results:permanent

Procedures• NOSE SURGERY

(Rhinoplasty)• Procedure:Reshape nose by reducing or increasing size, removing hump,

changing shape of tip or bridge, narrowing span of nostrils, or changing angle between nose and upper lip. May also relieve some breathing problems. (May be covered by insurance.)

• Length:1 to 2 hours or more.• Anesthesia:Local with sedation, or general.• In/Outpatient:Usually outpatient.• Side Effects:Temporary swelling, bruising around eyes, nose and

headaches. Some bleeding and stiffness.• Risks:Infection. Small burst blood vessels resulting in tiny, permanent red

spots. Incomplete improvement, requiring additional surgery.• Recovery:Back to work: 1 to 2 weeks. More strenuous activities: 2 to 3

weeks. Avoid hitting nose or sunburn: 8 weeks. Final appearance: 1 year or more.

• Duration of Results:Permanent.

Average Pricing• Arm Lift (Brachioplasty)$5000-6500 • Blue Peel$500-700 • Botox$200-400 per area • Breast Augmentation (saline) $5000-

6500 • Breast Augmentation (silicone) $6000-

8000 • Breast Lift$5000-6000 • Chin or Cheek Implants$3000-4500 • Collagen Injection$500-1500• Deep Chemical Peel$3500-5000 • Dermabrasion$2000-4000 • Eyelid Tuck (upper & lower)$4000-5500 • Face Lift$7000-9000 • Forehead Lift (Brow Lift)$3500-5000 • Hair Removal (Laser)$300-800

• Laser (Erbium)$2500-4000 • Laser (CO2)$4000-5000 • Lip Augmentation$600-2000 • Liposuction (1 area)$2500-4500 • Liposuction (3 areas)$5500-7000 • Liposuction (5 areas)$8000-10,000 • Medium Peel$1500-2500• Micro Peel$60-100 • Nose Surgery$5000-6000 • Pectoral Implants$6000-7000 • Permanent Eyeliner$300-1000 • Permanent Lip Liner$300-1000 • Spider Vein Rx (Laser)$400-1000 • Spider Vein Rx (Sclero)$200-500 • Tattoo Removal (Laser)$300-800 • Tummy Tuck$6000-8000

Appropriate Candidates

Two Categories

• Those who have a strong self-image, who are bothered by a physical characteristic that they’d like to improve or change. After surgery, these patients feel good about the results and maintain a positive image about themselves.

• Those who have a physical defect or cosmetic flaw that has diminished their self-esteem over time. These patients may adjust rather slowly to the results of their surgery.

Inappropriate Candidates

• Patients in crisis, such as those who are going through divorce, death of a spouse, or loss of a job. These patients may be seeking to achieve goals that cannot be obtained through an appearance change-goals that relate to overcoming crisis.

Post-operative Depression

• After surgery, most patients experience mild feelings of unhappiness, some cases might be more severe. After about three days prior to surgery when you may be regaining some of your physical stamina, your results have not begun to improve. Surgeons would call this “the Third-Day Blues”, this may last for a few days to several weeks. This emotional let down may be caused by stress, exhaustion, metabolic changes, or frustration.

Effects of Plastic Surgery

3 MAJOR AFFECTS

Your walletPhysical

Emotional

Main Risk

The main risks of plastic surgery operation are rejection of implants, sensory change in or around the operation site, decolourisation of the skin, tissue necrosis, asymmetry, infection, formation of bad scar tissue, and allergic reaction on the sedation.

These complications can be corrected by one or more additional operations. It is very important to be well informed before under going an operation.

Results

• They found that 87% of patients reported being satisfied with their cosmetic surgery outcomes. A year after surgery, 97% reported that they would recommend surgery to others and 93% say they would have the surgery again.

• A new study indicates that patients experience improved body image after undergoing common cosmetic surgery procedures, but the research did not suggest that participants experience decreased depressive symptoms or improvements in their body image-related quality of life.

Addiction

Some people appear to become addicted to cosmetic surgery, possibly because of Body Dysmorphic Disorder. Sufficient amounts of repeated cosmetic surgery can lead to irreversible damage to the normal body structure. However, due to the high cost of repeated cosmetic surgery, this disorder is generally one limited to the wealthy. However, others have been known to take out loans for repeat procedures.

Body Dysmorphic Disorder

• BDD is a mental disorder, which involves a disturbed body image. BDD is generally diagnosed of those who are extremely critical of their physique or self image, despite the fact there may be no noticeable disfigurement or defect.

• BDD combines obsessive and compulsive aspects which has linked it to the OCD spectrum disorders among psychologists. People with BDD may engage in compulsive mirror checking behaviors or mirror avoidance, typically think about their appearance for more than one hour a day and in a severe cases may drop all social contact. This disorder is linked to an unusually high suicide rate among all mental disorders.

Diagnoses of BDD

• The patient is preoccupied with an imagined defect of appearance or is excessively concerned about a slight physical anomaly.

• This preoccupation causes clinically important distress or impairs work, social or personal functioning.

• Another mental disorder (such as Anorexia Nervosa) does not better explain the preoccupation

Symptoms of BDD• Compulsive mirror checking, glancing in reflective doors,

windows and other reflective surfaces. • Inability to look at ones own reflection. • Compulsive skin-touching, especially to measure or feel the

perceived defect • Reassurance seeking from loved ones. • Social withdrawal and co-existent depression. • Obsessive viewing of favorite celebrities or models the

person suffering from BDD may wish to resemble. • Excessive grooming behaviors: combing hair, plucking

eyebrows, shaving, etc. • Obsession with plastic surgery or multiple plastic surgery

with little satisfactory results for the patient. • In obscure cases patients have performed plastic surgery

on selves, including liposuction and various implants with disastrous results.

Common Locations

• hair • nose • skin • teeth • genitalia • eyes • Facial structure • overall body build • legs • cheeks

• arms/wrists • lips • chin • stomach/waist • breasts/pectoral • buttocks • eyebrows • People with BDD often

have more than one area of concern.

Treatment• CBT (Cognitive Behavioral Therapy) coupled with

exposure therapy has been shown to be effective in the treatment. Low levels or insufficient use of serotonin in the brain has been implicated with the disorder and so SSRI drugs are commonly and with some success used in the treatment of Body Dysmorphic Disorder. Drug treatment will sometimes also include the use of an anxyolitic.

• BDD Tends to be chronic.

• Treatment should be initiated as early as possible following the diagnoses

What effect does plastic surgery have on children and

teenagers?

• In 2004, about 240,682 cosmetic procedures were performed on patients 18 years old or younger, and the top surgical procedures were nose reshaping, breast lifts, breast augmentation, liposuction, and tummy tucks.

When does changing your appearance qualify as BDD?

People with BDD repeatedly change or examine the offending body part to the point that the obsession interferes with other aspects of their life. Several studies show that 7 to 12 percent of plastic surgery patients have some form of BDD. Plus, the majority of BDD patients who have cosmetic surgery do not experience improvement in their BDD symptoms, often asking for multiple procedures on the same or other body features.

Does plastic surgery make patients feel better?

Studies have show that people report increased satisfaction with the body part that had surgery on, but results are mixed on whether plastic surgery boosts their self-esteem, quality of life, self-confidence and interpersonal relationships in the long term.

Continued

Some studies have even gone as far as linking dissatisfaction with cosmetic surgery procedures to suicide. For example, in one study, the National Cancer Institute found in 2001 that women with breast implants were four times more likely to commit suicide than other plastic surgery patients of the same age as the women who underwent breast implants.

THE EXTREME OF Plastic Surgery

Too many surgery procedures….led to this…

Micaela Romanini

Joceyln Wildenstein

The Ultimate…MICHAEL JACKSON