Cosmetic Surgery Facts

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Money not wisely spent can lead to expensive mistakes. Nowhere is this more true than with plastic and cosmetic surgery. We’ve often stated that just because a celebrity has a procedure done doesn’t mean you should jump in and do it, too. In fact, it’s almost a guilty pleasure to look at the before and after pictures of stars to see which ones have had cosmetic surgery that didn’t turn out so well. You know what we mean: Skin pulled too tight, overfilled with dermal injections and implants, or faces Botoxed to artificial-looking smoothness.

But when facial plastic surgery (such as face lifts, eye tucks, or forehead lifts) is done right and combined with cosmetic fillers and Botox, the results can be beautiful and look completely natural. In short, what you don’t know about plastic surgery can hurt your appearance and your budget.

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Should You Have Plastic Surgery?

Here at Paula’s Choice we are neither for nor against plastic surgery or cosmetic corrective procedures. What we are always for is knowing the facts—both the pros and the cons—rather than relying on the overhyped promises that some less-than-scrupulous cosmetic surgeons and dermatologists make. Information and realistic expectations are the only way to ensure you know what you are getting and what you’ll end up with.

Whether or not plastic surgery or cosmetic corrective procedures are right for you is a personal choice; each of us must make our own decision. You need to consider your expectations, the appearance-related issues you’re unhappy with, the alternatives, and your budget.

To help you make an informed decision about your options, we’ve prepared an overview of what is available, along with what you need to know about the risks and benefits of the different procedures. It all begins with finding the best doctor for the job—and then you and the doctor can discuss which procedure(s) are your best options!

How Do You Choose a Surgeon?

This may seem backward, but it’s often best to consult a plastic surgeon before you decide which procedures you want. You may not need a face lift or eye tuck when some type of laser or less invasive procedure can give you great results without surgery.

So, before you decide which procedure or procedures you want, the most important question is: Who should do your surgery? Given the growing number of doctors with cosmetic or plastic surgery practices, it is very difficult to know where to go, who to consult, and how to get started. And it certainly doesn’t help that there are so many doctors’ offices and facilities advertising their skills—via magazine, radio, and TV ads—and claiming that they’re the best!

Most people use one of four methods to select a cosmetic surgeon: (1) articles in fashion magazines, (2) finding out where celebrities went (everybody loves knowing where the “stars” are going for anything), (3) getting a referral from a friend or a friend of a friend, and, last but not least, (4) doing some research on the doctors who advertise their services.

These methods are not the worst plans of action, but they should be just the beginning of the process. You need to know more before you can make an informed final decision. Take the time to gather detailed information. Prepare a comprehensive list of questions on the following critical points:

  • Which procedures, both invasive and non-invasive, will meet your needs?
  • What are the pros and cons of each procedure (no procedure is 100% risk-free)?
  • Which doctors in your area are doing most of the procedures you’re interested in?
  • Are the doctors you’re considering using the latest devices, techniques, or tools, and, if so, are they using them because the tools really are superior or just because they’re new and exciting? The most recently developed method doesn’t necessarily mean it’s the best when it comes to surgery—you don’t want to be someone’s test case! That’s why, in most instances, you’re better off going with a more established procedure from a doctor who has had plenty of experience performing it.

Most important: Ask what can go wrong!

Shockingly, many physicians downplay any risks. A quick review of several cosmetic surgery websites reveals a scarcity of information regarding what can go wrong during or after a procedure—yet each and every medical or cosmetic corrective procedure has risks.

It’s true that only a small percentage of negative outcomes result from such procedures, only about 0.5%—4% (depending on whose statistics you use and what the procedure is) of all patients have some sort of problem or don’t like the results. But, when you consider that almost 15 million procedures were performed in the United States in 2013, that means there were at least 600,000 patients with problems, and potentially many more.

We don’t want to scare you—we just want you to know the facts, because it’s unlikely that someone at a doctor’s office will tell you, and facts are the only way to make a wise decision. You are the one who must decide your risk tolerance for these kinds of elective procedures and surgeries.

Cosmetic Surgery or Plastic Surgery?

The terms “plastic surgery” and “cosmetic surgery” are often used interchangeably, but they are not the same thing. Cosmetic surgery is subset of plastic surgery. The difference between a cosmetic or plastic surgeon and a “board-certified” plastic surgeon matters a lot! Training and credentials in surgery are the issues. Although a doctor may offer cosmetic, plastic, or aesthetic surgery, he or she may not be board-certified to perform that type of surgery. The person could be a gynecologist, pediatrician, or dermatologist with no training in cosmetic surgery whatsoever. Scary, huh?

“Board-certified” means the doctor has gone through very specific and extensive training in a specialized field and has passed a difficult examination administered by a board of experts in that field.

A non–board-certified cosmetic or plastic surgeon may be self-taught and may lack formal training in that field. Board-certified plastic surgeons, on the other hand, as mentioned above, have specific training and have passed rigorous qualifying exams.

You may hear those who are certified as plastic surgeons say why would you go to anyone but a board-certified plastic surgeon? They’re right, why would you? “Would you want your cosmetic corrective surgery performed by someone who has never had any formal plastic surgery training?” And that’s the issue; cosmetic surgeons may not have the training which is why the certification is so important. We can’t stress that enough.

One clear distinction that sets board-certified plastic surgeons apart is that they have privileges to perform plastic surgery at an accredited hospital. Although most cosmetic surgery procedures are performed in a doctor’s office, you want to be assured that your surgeon has a level of skill that is accepted by an accredited hospital.

It is completely fair to ask any doctor you see for a cosmetic surgery consultation whether he or she is board-certified, and, if so, which hospitals he or she is affiliated with. But that’s not the end of it! With that information in hand, the onus is on you to check to be sure the hospital is accredited and that the doctor’s certification is current and recognized by the American Board of Plastic Surgery (ABPS). That’s the only board recognized by the American Board of Medical Specialties (ABMS) to certify physicians for the full range of plastic and reconstructive procedures. To verify a surgeon’s certification status, contact the American Board of Plastic Surgery (phone: 215-587-9322; website: www.abplsurg.org) or the American Board of Medical Specialties (phone: 866-275-2267; website: www.abms.org).

Of course, there are great dermatologists and there are lousy board-certified plastic surgeons practicing plastic and cosmetic surgery. However, finding out first if that person is board-certified significantly reduces the odds of getting someone who is inexperienced. To be certified by the ABPS, a physician must have at least five to six years of approved surgical training, including a two- to three-year residency in plastic surgery. He or she must also have been in practice for at least two years and pass comprehensive written and oral exams dealing specifically with plastic surgery.

To obtain more information about physicians in your area who provide these kinds of services, visit the American Society for Dermatologic Surgery or call the American Society of Plastic Surgeons (phone: 888-475-2784).

What to Ask

After you’ve confirmed that the doctor is board-certified, you should continue to ask lots of questions, and listen carefully to the answers, until you feel comfortable and the answers make the most sense to you in light of your research.

Not all cosmetic surgeons will come up with the same game plan for you. Much like a chef has cooking methods they prefer, each surgeon has techniques he or she prefers, sometimes regardless of whether they represent the best or most current technology.

One of the most important questions you can ask a surgeon you interview is how often per month they perform the specific procedure or procedures you are considering. It is best (but not essential) to get a doctor who specializes in the procedure you want, as opposed to a doctor who performs many different procedures in an attempt to do it all.

Likewise, it is also imperative to ask how many surgeries the doctor performs per day. If the doctor schedules more than three procedures per day, it’s most likely that another doctor or a nurse will do the prep work and/or the finishing work. That may not mean poor results, but it does mean that there is the possibility the doctor will not always be the one who is doing the work. Make sure the doctor you are consulting will be the only person working on your face or body, and that he or she will never leave the operating room during your procedure.

It is also valid to ask if the doctor charges for redo’s and touch-ups. Although it’s obvious that plastic surgeons don’t want to admit it, it’s common for patients to make a return visit to fine-tune or to correct a mistake. You don’t want to be charged to have the doctor repair what you don’t like.

When to Do It

The options for changing your body or your face are almost limitless, and the results can be stunning. Traditional surgical procedures that cut off leathery, thick, lined, or sagging skin long abused by the sun can subtract years from a person’s appearance. Laser resurfacing can create baby-smooth skin and remove skin discolorations. Dermal fillers can plump up wrinkles and acne scarring, and undereye or underbrow bags can be de-puffed, making you look years younger.

In the past, most people waited until they were in their late 50s or 60s, and had noticeably aged skin, before they seriously considered cosmetic surgery. All that has changed with the advent of relatively noninvasive, low-cost procedures such as laser resurfacing, Botox, and dermal fillers, as well as new and more advanced surgical techniques that leave barely noticeable scars.

Obviously, having procedures performed at a younger age, before you “need it,” means having healthier-looking skin for years as opposed to an abrupt change when you finally decide you can’t take it anymore and seek a plastic surgeon. Besides, why wait until your skin is drooping and leathery before you do something about it? (In fact, you should be “doing something about it” in the way of a daily anti-aging skincare routine.)

If your friends and family say you don’t need surgery or a procedure, but there’s something about how you’re aging that really bothers you (and is beyond the reach of a great skincare routine), then it’s better to do something about it sooner rather than later. It’s your face and neck, your decision!

Women in their early 40s and 50s may want to undergo cosmetic surgery to deal with sagging corners of the mouth, slight pouching or sagging of the chin and jawline, and folds along the forehead. These irksome signs of middle age are easy to modify. Plus, having cosmetic surgery at this relatively young age slows the way the skin shows its age. Statistically, the most common age range for cosmetic surgery is 35–50, followed by the ages 19–34. People over age 65 account for the fewest cosmetic surgical procedures, so clearly, we’re not waiting too long!

Keep in mind that cosmetic/plastic surgery does not do it all as there are limitations as to what face lifts and eye tucks can achieve. For example, facial surgery cannot address crows feet, acne scaring, deep lines by the mouth, surfaced veins, skin discolorations, unwanted hair, and skin smoothness. A talented plastic surgeon will know how to combine surgery along with fillers, Botox, or lasers to achieve the results you want.

Does Starting Younger Help?

Some cosmetic surgeons suggest that laser resurfacing (such as Fraxel), Botox, and mini-tucks (doing a section of the face as opposed to an overall face-lift) performed when you are younger is the best way to delay the need for a full face-lift or eye tuck until you’re much farther along the road.

Having minor procedures performed as signs of aging crop up means there’s less trauma, better healing, and, because younger people generally have more elasticity and fat in their skin, the results last longer. Whether or not less invasive procedures or minor procedures decrease the need for eventual major surgery is not yet known, but there is something to be said for having the face you want now as opposed to later.

Still, we’re skeptical of the risk of having too many surgeries over the years. Aging doesn’t stop just because you’ve undergone some procedures, and if you have too many procedures it can make things look a bit unnatural and/or over-pulled. However, carefully performed non-surgical procedures can go a long way toward helping you look better and smoother even as the years march on.

It’s Up to You!

We are in a new era where cosmetic surgery is widely available. Some people are pleased to know their face doesn’t have to reflect their real age, and that they have a choice about what to do about it. As long as the results are impressive (and they often are), most people will want to maintain their youthful appearance via procedures that are relatively low risk and relatively permanent.

Wondering about that word “relatively” above?  We used it because cosmetic surgery has duration limitations; that is, having a procedure will not keep your skin age-free forever. That’s neither bad nor good, but some of these processes are legitimate options for creating the look you want. Plus, it beats wasting money on creams and lotions that might do nothing for the wrinkles or sagging or pouching that bother you the most.

Skincare can do a lot to prevent and repair signs of aging, but any cosmetic surgeon worth getting to know would agree: When it comes to correcting signs of aging, the combination of a brilliant skincare routine with the right cosmetic surgical (or non-surgical) procedures is the smartest way to go.

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About the Experts

Paula Begoun is the best-selling author of 20 books on skin care and makeup. She is known worldwide as the Cosmetics Cop and creator of Paula's Choice. Paula's expertise has led to hundreds of appearances on national and international television including:

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The Paula's Choice Research Team is dedicated to helping you find the absolute best products for your skin, using research-based criteria to review beauty products from an honest, balanced perspective. Each member of the team was personally trained by Paula herself.

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