Cosmetic Surgery Facts

Looking and feeling good continue to be strong trends among women, according to a new report from the American Society of Plastic Surgeons (ASPS). Cosmetic surgery procedures among women have increased by 16 percent since 1992. Liposuction, breast augmentation, and eyelid surgery remain the most popular procedures for women wishing to enhance their appearance. In 1999, almost 500,000 women had one or more of these three popular procedures, up 26 percent from 1998. ASPS statistics represent procedures performed by ASPS member plastic surgeons certified be the American Board of Plastic Surgery (ABPS) or the Royal College of Physicians and Surgeons of Canada.

"Not only have these three procedures remained the most popular, but the number of women opting for these surgeries has increased significantly," explained ASPS President S. Lin Puckett, M.D. "It is not surprising these procedures help patients achieve the look they have been striving for, which exercise and skin care won't change. Also, many times the procedures give patients a boost in self-esteem."

Top Cosmetic Surgery Procedures Among Women

*Other top plastic surgery procedures chosen by women include rhinoplasty, with 94,317 procedures performed and facelifts with 92,558 performed in 2000.

The 2004 statistics on Cosmetic Plastic Surgery have been released. Visit the ASAPS website at www.surgery.org for top procedures, gender distribution, etc.

Men's Cosmetic Surgery Procedures on the Rise

Many think that cosmetic surgery is just for women, but times are certainly changing. Liposuction is now the most frequently performed procedure on male patients. According to the American Society of Plastic Surgeons (ASPS), in 1999, almost 11 percent of cosmetic surgery procedures were performed on men, up around 27 percent from the previous year.

Liposuction comprised 28 percent of the total number of these tracked procedures for men. "These figures certainly show a change in the gender gap," explained ASPS President C. Lin Puckett, MD. "Men are becoming as concerned about remaining fit and trim as women. Because liposuction removes localized fat that doesn't respond to dieting and exercising, it is the best procedure to help men attain their desired body shape."

There has been about a 50 percent increase in cosmetic surgery procedures among men since 1992, with the most popular of these being liposuction, eyelid surgery (blepharoplasty) and nose reshaping (rhinoplasty). In 1999, the number one male procedure with a 38 percent increase since 1992, is liposuction, followed by eyelid surgery with a 14 percent increase. Rhinoplasty is the third most frequently performed procedure for men.

Top Cosmetic Surgery Procedures Among Men

Body Contour Surgery-What's New?

Liposuction
Liposuction, in only about 15 years since its inception has become the most commonly performed cosmetic procedure. With this procedure, fat is removed using small tubes (cannulas) introduced through small incisions utilizing vacuum suction.

While growing in popularity and performed mostly on an outpatient basis, this is a "real" surgical procedure and should be approached as such. The bleeding, and contour irregularities.

The procedure does best for "localized" fat deposits and is not a "weight loss" technique. Results are permanent and usually look quite natural especially if the patient is committed to maintaining the new shape with a sensible diet, exercise and a healthy lifestyle. "Cellulite" is not affected by this technique nor is there much effect on skin quality.

Since they are experts on all types of body contour surgery (a part of a plastic surgeon's core curriculum training) a consultation with a board-certified plastic surgeon is one of the best ways to obtain the facts on whether this procedure is applicable to you.

A few definitions may be helpful:

Tumescent liposuction refers to a liposuction technique in which a large volume of fluid containing salt water and dilute solution of epinephrine (adrenaline) is injected into areas to be aspirated. This fluid cuts down on blood loss, pain, facilitates the procedure and possible cuts down on bruising. It can also provide excellent local anesthesia to treated areas.
It is important to monitor the amount of fluid used as fluid overload and toxic effects of large amounts of the local anesthetic can occur. This had led many surgeons, in recent times to "reduce" the amount of fluid used: a so-called "super-wet" technique in which less fluid and local anesthetic can utilized.

My personal preference is to utilize general anesthesia in many cases except for very small areas and "small" secondary touchups. Patients are usually much more comfortable and smaller amounts of "tumescent" fluid can be used. This anesthesia is best managed by board-certified nurse anesthetist. Around 5 liters (5000 cc's) of aspirate can safely be removed on a outpatient basis. Larger amounts can be removed, however, usually involve an overnight hospital/ surgery center stay.

Ultrasonic liposuction is another procedure designed to accomplish body contouring and utilizes ultrasonic high energy waves to break up fat before its aspiration. It has its most use in more fibrous areas such as the flanks and male breast, otherwise I believe comparable results can be obtained with traditional liposuction. Ultrasonic liposuction or UAL has some added disadvantages which include: seromas (fluid accumulations), skin burns, increased expense and operating time and slightly larger incisions.

Power-assisted liposuction (PAL) utilizes power equipment to assist the surgeon with the mechanics of traditional liposuction. It has no added risks or expense as compared to UAL and by facilitating the surgeon's efforts may have an overall benefit to the entire contour procedure.

Consultation with a board-certified plastic surgeon who is trained in all aspects of body contour procedures form traditional surgeries such as abdominoplasty and various "lift" procedures to the utilization of new technologies such as liposuction to accomplish these goals is the best way for a patient to explore his/her options. The patient's safety for the procedure is also of prime concern to the plastic surgeon who is trained in proper fluid management, surgical skills and surgical judgment. Again, liposuction is a SAFE surgical procedure which when performed by a board-certified plastic surgeon, can be very effective in accomplishing body contour procedures.

Here are some additional points to remember:
•It's important that the patient has realistic expectations. Liposuction will not cure obesity. The procedure is generally recommended for patients of normal weight who have localized fat deposits that have been resistant to exercise and diet. Good candidates for liposuction are the patients who are within 30 percent of their ideal body weight and have adequate skin elasticity to ensure good cosmetic results.
•It's valuable to thoroughly discuss the procedure. Above, we talked about tumescent and superwet techniques (these both involve monitoring the ratio of injected fluid to the liquid, including fat, removed during liposuction). Proper fluid management is one of the fundamentals of a board-certified plastic surgeon's training in caring for their patients.
• Some patients (and their doctors) may prefer local anesthesia, or epidural anesthesia (with or without conscious sedation), many patients want to sleep throughout the procedure. We believe that general anesthesia should be administered by a board-certified/board-eligible anesthesiologist or a certified registered nurse anesthetist.
• The value of discussing risks and postoperative care. Liposuction is serious surgery and it should only be done when a patient understands the risks. There is more risk of complications with multiple procedures and with longer surgical sessions. Liposuction is often performed as an outpatient procedure but if more than five liters (5000 ccs) of fat and fluid are removed, the patient should have an overnight hospital stay.

For more information, please see our Liposuction page.

Breast Augmentation News

Once the most popular procedure, breast augmentation is the first for women ages 19-34 years. During the '90's there was concern and "controversy" about the safety of silicone gel implants, and although saline implants remained a viable option, their use too dropped off as plastic surgeons and the FDA looked to establish the safety of these devices. The FDA ruled on May 10, 2000 that saline filled implants manufactured by Mentor and McGhan corporations could continue to be marketed and used in women over 18 years of age for breast augmentation.

A number of studies have looked at these safety issues as well as various somatic complaints (e.g. aches, pains in the neck, trunk and extremities) and most conclude there was no connection between "autoimmune" disease and "somatic" complaints and breast augmentation. Over 50% increase in breast augmentation procedures was seen between 1998 and 1999. My personal preference in recent years has been to use saline implants which can be adjusted for asymmetric in breast volume between the two sides. The location I prefer is inframammary which provides the most direct approach to the implant pocket and after healing, this incision is difficult to see under the curve of the breast.

Other incisions are located under the arm and along the bottom curve of the pigmented areola. I often put the implant beneath the muscle as this provides an extra layer of tissue to protect the implant and the muscle contraction during normal activity may keep the implant softer by keeping the implant moving. "Round" implants are quite satisfactory and they are probably assume a more "tear drop" or "anatomic" shape in the body.

There are indications for other types and shapes of implants and placement above the muscle which options are best discussed with the patient during consultation. Deflation rates for saline implants are low and most manufacturers provide replacement implants in these instances.

For more information, please see our Breast Augmentation page.

For more information on Silicone Breast implants, please visit www.breastimplantsafety.org. This site is a joint venture of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery and exists to give a fair and honest assessment of breast augementation surgery.

Sun Safety Tips

Skin is the largest organ of the body and offers considerable protection against the environment including radiation, chemicals, physical agents, etc. Skin cancer is the most common form of cancer with 500,000 new cases each year. Ultraviolet radiation, mostly sun-related, is a major cause of skin cancer and with younger people getting more sun exposure, these cancers are showing a rise in the age group. The effects of sun damage are cumulative over time, so living in the sunbelt provides ample opportunity for sun damage to accumulate.

Plastic surgeons play a major role in the treatment of these tumors with both excision and reconstructive surgery, the plastic surgeon can plan the excision of these tumors in such a way as to preserve function and prevent deformities such as scar contractures. In addition to utilizing various techniques to restore surface areas with e.g. flaps and grafts, whole or partial units may need restoration: e.g. on the face, a nose or eyelid or maintenance of a hairline.
His aesthetic training serves the plastic surgeon well particularly on these areas.

In addition to his general plastic surgery training, Dr. Lugger has also had additional training in facial plastic surgery during his otolaryngology (ear, nose, throat, head and neck) training. Skin cancers usually appear on exposed parts of the body, therefore sun protection is a major way to prevent skin cancer. Use a sunscreen preparation that protects you from both UVA and UVB rays and look for a product that has an SPF (sun protection factor) of at least 15-30. These products should be applied around 20 to 30 minutes before going outdoors so as to allow the product to bind to the skin's surface. With swimming or sweating reapplication should be done even with "waterproof" varieties. Hats are also helpful and sun protective clothing is also a good preventative.

It is best to avoid the sun between the hours of 10 AM to 3 PM.
Don't forget to protect areas such as the ears, scalp, back of the hands and feet.

There are three types of skin cancer: basal cell, squamous cell and melanoma.

Basal Cell
Basal cell cancers are the most common occurring mostly in sun-exposed areas. They are often raised with a smooth surface upon which delicate blood vessels can crust and bleed. Often the border is raised more than the center and with growth the center can ulcerate. These lesions tend to bleed and do not heal, usually persisting over a month. They are treated with excision and usually do not recur. They do not metastasize. If left, untreated, although they tend to stay in a localized area and can cause considerable deformity.

Squamous Cell
Squamous cell cancer is the second most common form of skin cancer, often originating in pre-malignant sun damaged areas. They usually have a rough, scaly surface and usually occur on exposed surfaces although they can occur on unexposed areas. They can grow rapidly and can metastasize. Treatment is surgical excision.

Melanoma
Melanoma is the worst type of skin cancer which can spread internally and cause death. They are most commonly pigmented- brown or black although multiple colors can be present such as red-brown, violet, blue or white. They occur with greater frequency on the backs of men and the legs of women.

Skin Self Exams

The A-B-C-D rule is a helpful guide in evaluating a suspicious skin lesion:

AAsymmetry: i.e. by dividing a mole or spot in half, one side is different from the other

BBorder: this should be regular- not ragged or with jagged edges.

CColor: suspicious lesions may contain a variety of color.

DDiameter: worrisome lesions are usually bigger than the end of a pencil eraser, 1/4 inch or more.

To sum it up: Prevention & Early Detection Are Key
Skin cancer, if not completely preventable, can at least be successfully treated if caught early. Here are some ways to protect yourself.

•Stay in . Avoid the sun between 10 a.m. and 4 p.m., when the sun's rays are strongest.
•Cover up . Wear long pants and shirts with sleeves. If the sun can't get to you, it can't damage your skin.
•Wear a hat . To protect your face and neck, your hat should have a 4-inch brim.
•Make it routine . Use a broad-spectrum sunscreen every day and start putting it on your kids at age 6 months. Go higher. If you'll be outside for any length of time, use a sunscreen with an SPF of 30-no less than SPF 15.
•Reapply. Even waterproof sunscreens need to be reapplied every two hours for maximum protection in the midday sun.
•Look for changes . Growing, bleeding, crusting, or otherwise changing spots on skin could indicate a problem.
•Get to know your skin . Practice skin self-exams to become familiar with your body's "topography."

Skin Cancer: The New Epidemic

Treatment for melanoma is mainly surgical as other treatment such as chemotherapy and radiation are usually only of limited help. Prognostically, the melanoma's thickness and the depth to which it has penetrated help determine treatment. For this reason, the melanoma is removed completely and widely ensuring no aberrant cells exist beyond the borders. Even it a mole has been present for many years, any recent change, such as increase in size or bleeding should be evaluated.

Skin cancer is usually diagnosed with a biopsy : a technique where a portion or all of the tumor is removed and submitted to a pathologist for diagnosis. Fortunately, skin cancers can be seen, however they often change , e.g. appearing to improve or get smaller, therefore it is best to have them evaluated rather than becoming complacent about them. Examine yourself in front of mirror or have someone else check areas you cannot see; note in particular anything different or changing.

Some lesions are "innocent" whereas other may be cancerous or precancerous. Actinic keratoses are often little scaly spots that are slightly raised with an irregular border or reddish background, and may be precancerous.

Potential candidates: People who have had several blistering sunburns in youth or adolescence, or those with a family history of the disease. Treatment: Removal of the tumor (excision). The amount of tissue that needs to be cut out depends on the tumor's thickness, so early detection means less invasive surgery. If the cancer has spread, the patient may need chemotherapy, radiation, or other treatments. Vaccines, and the study of genetics as it relates to melanoma, are important advances in helping to prevent recurrences.