Is Plastic Surgery Right for You?

With today's cultural emphasis on health, longevity and wellness, cosmetic surgery has become a popular accepted extension of improving one's self image.

At a press conference on "Redefining Vanity", a social psychologist at Stanford University described a new world in which plastic surgery is acceptable and unstigmatized; a world in which it is "healthy" to do whatever it takes to feel better about yourself. It is a world in which "women and men are increasingly pro-choice about appearance enhancement."

Women generally do not list aging, career advancement, or attracting a mate as their primary motivation for cosmetic surgery – the top reason given by most women is to feel better about themselves. Cosmetic surgery today is not just about self as in 'selfish'. It's about self as in 'self-worth', 'self-confidence' and 'self-fulfilling'. To suggest that changing one's looks can profoundly affect the quality of one's life is extreme; however, small details of our appearance can be critical determinants of how well we do in our personal life, interactions amongst friends and our professional life.

The circumstances for each individual will be unique. While making the decision whether or not one is a good candidate for cosmetic surgery, it is important to consider the following: nasal surgery will never cure depression, a tummy tuck will not secure a job for which one is not qualified, and a breast reduction will never make your parents or boyfriend love you more.

What cosmetic surgery can provide is the combination of a self-confidence boost and the edge that good looks confer in this society. Potential patients who seem seriously depressed or looking for a quick-fix or impossible results should consider other means for addressing issues that surgical intervention could never resolve. Some patients will take heed in this advice while others will continue to look for a surgeon willing to perform the "quick-fix". However, the vast majority of people who want a breast augmentation, nasal surgery or liposuction are not emotionally unstable or selfish people. They are realistic women who think a smaller nose, slimmer thighs, or bigger breasts will make them feel good about themselves and be noticed and approved by others.

Can plastic surgery change your life? Yes. Will it? That depends on several factors, most notably: what you look like, what you think you look like, and what aspect of your life needs changing. If your answers point toward having cosmetic surgery, go for it – and focus on how wonderful the new you is going to feel.

Leg Lengthening Plastic Surgery

In a world where height is greatly valued, some people are willing to undergo brutal, greatly painful and enormously expensive leg lengthening plastic surgery to gain an extra couple of inches.

Leg lengthening is often done in other countries, with regulations that are different from those in the United States. The cost is often upwards of $100,000 and typically patients gain only 2-4 inches. To cut costs, and spend only $10,000, patients travel to all kinds of foreign countries and return with more problems than just being on the small side.

On his blog, Dr. Anthony Youn describes the exceedingly painful procedure, "This is a surgery where the bones of the legs are sawed in half and then gradually allowed to spread apart as new bone grows between the two broken halves. It's called the Ilizarov technique, and has been used for healing fractures for years. It's only recently making news as a technique for making a person taller."

He also warns, "Unfortunately, bone lengthening is a tedious process which can result in a major complication like osteomyelitis (infection of the bone)."

Recovery time is significantly longer than other cosmetic procedures at 10 weeks, rather than 10 days. The surgery carries great risks, including deformity and infection. Still there are an estimated 4,000 men in the world that have elected to undergo the procedure.

Parents choose surgery to reshape baby's skull

Ten fingers. Ten toes. Nine pounds, six ounces of boy -- a "Matthew" at last, after an Addie and a Gracie. A blue blanket for the Hodgson family.

Born April 28, Matthew Hodgson looked perfect in the way all young parents hope for their newborns.

But in the happy rush after the Caesarean-section delivery, Holly Hodgson noticed Matthew's head was misshapen -- wide in the front and narrow in the back. And there was a knot on the back of his skull.

Three months later, on July 24, Matthew would undergo a delicate surgery at St. John's Hospital to remove parts of his skull and reshape it, while Holly sat in the waiting room, clutching the blue flannel blanket.

Rare condition

It's called "the soft spot."

When a baby is born, the seven bone plates of his skull are not yet "fused," or grown together. That allows the newborn's brain to grow to its intended size.

But in 1.6 newborns out of 1,000 births, one or more of the spaces or "sutures" between the bone plates close prematurely.

It restricts the brain's growth, forcing it to grow in any direction the skull will expand.

The condition is called "craniosynostosis."

Matthew had the most common form -- only one suture had fused lengthwise down his skull, giving his head a boat shape.

In more rare cases where two or more sutures fuse prematurely, the pressure of the growing brain can distort the shape of the face, eye sockets and jaw.

It can also cause increased cranial pressure, vision problems, and some doctors believe it causes developmental delays and brain damage.

Others believe a child's development is more affected by the deep psychological effect of going through life with such a severe deformity.

Researchers think the condition is caused by a problem with genes that determine growth.

It's not considered inherited -- Matthew won't necessarily pass it on to his children. But the condition shows up in families, doctors say.

When tests confirmed Matthew's condition, his parents' hearts sank. They could forgo surgery and face long-term consequences, or schedule the procedure.

It would be major surgery and meant a four- to five-day hospital stay. And there would be three years of follow-up visits.

Holly and her husband, Kerry, considered the alternative.

Holly concluded, "We have to do it."

Reshaping skulls

Not all misshapen heads are from craniosynostosis, however, said St. John's pediatric neurosurgeon Dr. Sami Khoshyomn.

In fact, only about 20 of the roughly 250 children that he sees for skull deformities each year require surgery.

The birth process can temporarily mold a newborn's head out of shape. Infants who are consistently placed on their backs to sleep can develop a flat skull.

Early diagnosis is important, Khoshyomn said. Surgery between 3 and 5 months old offers the best results. Infant skulls are easier to mold and heal rapidly.

Doctors who have performed the surgery over the past 34 years report that it is more difficult and the risks are higher after the child's first year.

Some families choose to travel out of town for the surgery, a cost hardship for many and far from family and friends. The Hodgsons learned a team in the health care system they use offered the procedure in Springfield.

St. John's Dr. Khoshyomn and Dr. Bharat Shah, a plastic reconstructive surgeon, and their neurosurgery team have been surgically correcting the congenital skull deformities for about two years. Neurosurgeons at Springfield Neurological & Spine Institute, aligned with CoxHealth, also do craniosynostosis surgery.

The St. John's team has done about 20 procedures in two years, the same number surgeons at a St. Louis children's hospital said they've done in the same period, Dr. Khoshyomn said.

He and Dr. Shah explained the details of the surgery for the Hodgsons, from the lengthy pre-surgery prep, expected recovery time and scarring, and the surgical risks -- bleeding and infection.

Holly also talked to another family whose 6-month-old son had the same surgery months before. He's doing great, she said.

"It was kind of a relief," she said.

Saying goodbye

After daybreak on July 24, with Matthew bundled in the blue flannel blanket, Holly and Kerry cradled him at St. John's before surgery.

Soon a nurse came in.

"She let us give him a kiss goodbye," then gave the blanket to Holly and carried him into surgery. "Carried him," she said, instead of laying him on a gurney. "That made me feel better."

Kerry and Holly settled in the waiting room, surrounded by parents, in-laws and church friends.

"I know he's not going to know or feel anything," Kerry said, "but nobody wants their child to go through that. We handed him over this morning, wishing we could take the pain for him. They're so fragile and little..."

Under the knife

In the operating room, the surgery team spent two hours preparing Matthew for the procedure. Infants require meticulous care with anesthesia and monitors for blood levels and blood pressure.

The surgeons spent 30 minutes, alone, placing Matthew's body in the precise position -- "like a sphinx," the surgeons said.

The nearly two-hour surgery began with a zig-zag incision across Matthew's scalp from ear to ear, allowing access to his skull.

Then Dr. Khoshyomn made the first cut lengthwise down the skull, mindful of the brain's largest vein just below the incision.

Any injury to that can cause serious blood loss -- the single most-worrisome complication of the surgery, Dr. Khoshyomn said.

"Not injuring that vein is the only thing that gets my heart beating," he said.

The complication occurs about once every two to three years in the United States, he said.

The surgeons keep blood reserves on hand for that reason.

Once he made the cuts, Khoshyomn removed pieces of the skull bone in a T-pattern across the top of Matthew's head.

"The instant you remove that (closed) suture, you can actually see the head widen because it's been constricted all that time," Dr. Shah said.

At that point, Dr. Shah gently remodeled Matthew's skull with his gloved hands and specialized bone-bending instruments.

The repair was secured with four plates and 24 pins made of a material that over time absorb into the skull.

Dr. Shah then closed the incisions and skin flaps with about 100 reabsorbable stitches.

"Matthew's surgery went very smoothly, and he did very well," Dr. Shah said. "The bone reshaping was exactly as planned, and the absorbable plates and ultrasonic screws worked well."

The technical science, however, was lost that morning on the anxious Hodgsons, who wrung the blue blanket and waited for word of their son.

Life after surgery

When the doctors met the family after surgery with the good news, Holly said, "I was just so relieved to see them and to know it was over."

Matthew would have some swelling and a zig-zag pattern across his scalp that would disappear under hair in time, they reassured the parents.

He would soon switch from morphine to Tylenol for several days, but he wasn't expected to have much pain.

When the Hodgsons finally saw their baby that Thursday afternoon, Holly remembers thinking the swelling didn't look so bad.

His ears stuck out -- "like a little Mickey Mouse."

By Friday morning, a nurse was feeding him a bottle.

"He opened those big eyes and gave us a great smile," Holly said.

Matthew went home that Sunday to his own crib, where he sleeps contentedly every night bundled in his blue blanket.

"He's a happy little boy, smiling all the time," Holly said.

Within weeks, Matthew will be measured for a "cranio-molding helmet," which he'll have to wear 20 hours a day for three to six months.

It will help speed the reshaping process. He isn't expected to have any residual issues or pain from the surgery.

The estimated total cost of Matthew's ordeal could fall in the range of $44,887 and $61,111, hospital officials said.

Dr. Khoshyomn doesn't want cost to discourage families from seeking help -- "We put zero barriers based on a patient's ability to pay for children," he said.

The Hodgsons hope their insurance will provide, "but it's worth it," Holly said.

"I do all kinds of surgery," Dr. Shah said, "and this definitely is the most important.

"You get big results, and you know that you've made a big change in that child's life."

Weight reduction surgery weighs on bank account

NANAIMO -- Shari Lychak has about 40 pounds of excess skin hanging from her body, which when she lies down feels like a pile of blankets underneath her body.

She lost 300 pounds in less than three years after undergoing bariatric bypass surgery in 2006, transforming her stomach into a small pouch the size of a golf ball. The surgery, combined with a rigid exercise routine, saved her life, but Lychak -- and many others like her -- are left with a hefty bill because the reconstructive surgery is meagrely covered by the province's medical service plan.

Lineups for the weight-loss surgery extend to 900 people and it can take as long as four years before a patient goes under the knife. That means a large number of British Columbians suffer the unhealthy side-effects of losing so much weight, according to a group lobbying the B.C. Ministry of Health to share the cost. MSP currently does not cover the cost of the "cosmetic" surgery, but people like Lychak say the health implications from having so much skin reaches far beyond cosmetics.

The ministry recognizes the "need for plastic surgery following significant weight loss" and has "asked for a review of the criteria for coverage of this type of surgery," according to a statement, but the changes, if any, can't come fast enough for those in line for bariatric surgery.

"Even if the ministry changes the coverage, it will take too long to impact me," Lychak said. "We want this for every other person that goes through this."

The excess skin causes a range of health issues. Without supportive undergarments, the skin hangs to just above Lychak's knees and cuts off the circulation to her legs. When she wears the support, she loses circulation to her legs when she sits down. To avoid rashes or skin ulcers, she coats the flaps with underarm deodorant.

"It's a health issue. There are a range of hygiene problems that come with this," she said. "It's not like I'm looking to wear a bikini."

When she sits on the toilet, she has to pull from behind to tighten the skin just to use the muscles in her butt, "an everyday task that most people don't think about," she explained.

Lychak is a healthy 190 pounds, but unfortunately her skin has lost its elasticity after shedding so much fat. She is left with the reminder of her old self and risks further health problems if she can't afford the $20,000 for the surgery. MSP covers $295 of a panniculectomy, a procedure that removes the excess fat and skin from the abdomen, but does not pay for a full abdominoplasty, or tummy tuck.

"I don't understand why this is considered a cosmetic procedure," said Lychak. "I'm happy I had the [bariatric] surgery because I would probably be dead, but this is a difficult way to live."

She has always been a large woman; it runs in the family. Her mother was obese and so was her father. Lychak could eat healthy, eat less and exercise regularly, but she could never lose more than 100 pounds. And when she did, she eventually gained it back.

At nearly 500 pounds, she managed to continue her job at Central Drugs on Bowen Road, but staff had to get her a chair to sit in so she could do her work. Just before her surgery, she required rides to and from work because her size prevented her from walking the three blocks to her house.

Rejuvenate your skin

Want to bring back your skin's lost lustre, but the thought of surgery scares you? Well, don't fret about it, for there are a whole arsenal of aesthetic procedures that work without visibly wounding the skin.

Dermatologist Arielle N B Kauvar, clinical associate professor of dermatology at New York University School of Medicine, has revealed the latest non-surgical options in skin rejuvenation for treating photodamage and pigmentation problems, wrinkles, textural changes and loose skin.

"As we age, the majority of these skin problems are a direct result of long-term sun exposure. Also, the loss and movement of the underlying fat layer of the skin over time causes us to lose volume in our skin – creating that 'sunken in' look. Fortunately, we now have a number of minimally invasive procedures that can be used either alone or in combination to combat the telltale signs of aging," said Kauvar.

For problems ranging from pigmentation, splotchy skin, redness due to enlarged vessels or capillaries, to dry, dull skin and loss of collagen, Kauvar suggested minimally invasive lasers and light sources that target affected areas of the skin with varying wavelengths and pulse durations without injuring the top layer of skin.
Kauvar added that peeling procedures can also improve the overall radiance of the skin and also remove some of the abnormal pigmentation from sun damage. Although wrinkles are perhaps the most obvious changes that occur, enlarged pores and even acne scars often worsen as we get older, resulting from the loss of collagen.

For treating large pores, Kauvar recommended the use of non-ablative lasers to heat the layer of tissue in the superficial dermis, resulting in the production of new, thicker and smoother skin. While non-ablative lasers are designed for patients with superficial skin damage who are not expecting dramatic results, fractional non-ablative lasers can deliver better results for patients with more extensive signs of aging.