Mirror Mirror



If the new year finds you looking critically in the mirror and vowing to improve what you see, you are not alone. Physical beauty might be fleeting, but many Americans are doing their darnedest to capture and preserve it. Nearly 12 million cosmetic plastic surgery procedures were performed in 2007, a 59 percent increase from 2000, according to the American Society of Plastic Surgeons (ASPS).

For those seeking a certain standard of beauty, or just a more youthful look, a bevy of beauty options awaits. Today’s most popular cosmetic procedures are minimally invasive and usually require little healing and downtime. They allow patients to achieve aesthetic results without the cost or commitment of traditional, more permanent choices, like facelifts or other surgery.

Botox, for example, tops the most-requested list. It minimizes the appearance of wrinkles by temporarily subduing muscle action through facial injections. Facial fillers are also popular with patients. Products such as Restylane and Juvederm plump out the face to help restore what age, gravity, or serious illness have taken away. They help recreate the appearance of bone or collagen, providing “a better foundation for the skin of your face,” says Yolanda Troublefield, MD, medical director and ENT/facial plastic surgeon at The Medical Cosmetic and Laser Group at SKIN in Nashua.

Botox typically lasts for four to five months, says Wayne K. Stadelmann, MD, of Stadelmann Plastic Surgery in Concord, while results from dermal fillers can last from four months to more than a year, depending on the type of filler used. Stadelmann says that he “very rarely” uses permanent fillers such as Artefill, noting that their effects will remain visible indefinitely, whether the patient is happy about it or not.

Another filler-type choice at first glance seems to offer two-for-the-price-of-one appeal. In a facial fat grafting procedure, the physician removes fat from one part of the patient’s body, purifies it, and then injects it into the facial skin to create more fullness. Alas, the amount of fat that is removed is miniscule. Usually about half of the fat survives the transfer, Stadelmann says, with the rest being absorbed by the body, leading most people who opt for facial fat grafting to repeat the procedure before they are comfortable with the results.

The seekers
Men typically make up 10 percent of cosmetic surgery patients, often seeking facial dermal fillers, Botox, hair removal, or male breast development surgery. The typical male patient profile is changing as men become more savvy cosmetic consumers, Troublefield says. Today, many of her male patients are Granite Staters who work outdoors and have sun-damaged skin as a result. “They’ve got a lot of blood vessels and capillaries in their skin that have been damaged and ruptured,” and want to have those treated, often along with back hair removal.

Patient age varies widely, Stadelmann says, with some young female patients requesting breast augmentation, liposuction, and abdominal contouring. Patients aged 35 to 50 primarily seek dermal fillers, Botox, and tummy tucks. Women between the ages of 50 and 65 frequently request eyelid surgery, dermal fillers, Botox, or facelifts. Over the age of 65, most of the patients desire facelifts, he says.

Lasting effects
Minimally invasive procedures like Botox, fillers, chemical peels, and microdermabrasion, which buffs away imperfections in the skin, often appeal to patients who want quick results, little downtime, and relatively little damage to their wallet. But the effects of these methods are limited, Stadelmann says. “Botox and dermal fillers do not replace a facelift, but they buy you some extra time before benefits begin to have a decreasing return for the investment,” he says. Eventually, those who opt for the less-invasive techniques might find that they need to consider a more radical procedure, such as a facelift, if they wish to maintain a youthful appearance.

For patients more concerned with smoothing out saddlebags than wrinkles, liposuction continues to be a popular choice. Liposuction is not really meant for the very obese, though, says Stadelmann. “Liposuction is not designed to be a weight-loss modality,” he says. “The most fat I ever take off would be about three to four liters at a time, which is not much fat.” Liposuction is really more of a recontouring procedure, he says, taking down small elevations and smoothing them to look more pleasing.

Stadelmann does see an indirect, increased interest in weight-loss-related surgery, however. Massive weight loss resulting from gastric bypass procedures or diet can lead to excess skin that does not shrink or retract. As a result, “We’re frequently called upon to do tailoring procedures to remove excess skin, especially over the lower stomach and the arms,” Stadelmann says.

Going for the gusto
Those looking for more radical change often sign up for a facelift, breast augmentation, nose reshaping, eyelid surgery, or a tummy tuck. Patients should note that although facelifts and eyelid surgery are permanent, they do not stop the aging process. “Typically you can turn back the clock, say, five years or six years with a facelift,” Stadelmann says. “You’ll always look five or six years younger, so when you’re 70 you’ll look like you’re 64; when you’re 80 you’ll look like you’re 74. Those results are sustainable, but they don’t arrest the aging process.”

Indeed, a traditional facelift “can redrape the skin, but over the existing foundation,” Troublefield says, which will continue to erode with the passage of time.

Buyer beware
There are two recurring myths that Stadelmann encounters among patients. One is that cosmetic surgery will not result in a scar. “Any surgical procedure has a scar,” he says. “Scars are unavoidable. Our goal is to make it as imperceptible as possible.”

Another mistake some patients make is focusing too heavily on convenience and cost. “If someone’s advertising a weekend facelift, it’s not really a facelift,” Stadelmann says. “If you want to see really good results, you have to pay the price. You have to expect some downtime, some bruising, and some self-imposed social isolation while you’re recovering.”

Troublefield agrees, warning patients to be careful of “mall fluff and buff.” More and more little shops are opening up and offering cosmetic services, she says. It should probably go without saying, but: caveat emptor. Especially when you’re talking about someone dealing with your face or wielding a laser aimed at some other part of your body, think twice before visiting the discount guy on the corner.

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