Americans are opting for cosmetic surgery in record numbers. But do they know the risks?

Makeover Nation

By Nancy Shute

Posted 5/23/04

When Phyllis Bradshaw's twin sons went off to college, she decided it was time to better herself. She started exercising, ate better, and began writing a novel. Then the Lewisville, Texas, ex-airline reservation agent went in for surgery to remove excess skin from her upper eyelids. She liked the results so much that she decided to have her neck and stomach done, too. "I'm not trying to look gorgeous, 20, Barbie," Bradshaw, 49, says. "I'm just trying to get rid of the things that are hanging." Her husband hated the idea, so she went to the bank and borrowed the $20,000 herself.

Last December, Bradshaw spent two days in the hospital. For the next few weeks she was too stiff to drive a car or turn her head to the side. "I could not believe how painful it was--like sharp lines up and down my stomach." But, she says, the results are "very natural, which is what I like." Her husband is happy, too. "I never thought much about plastic surgery before," Bradshaw says. "But it is amazing how many people are doing it now."

Amazing indeed. Americans are rushing to get tucked, suctioned, tightened, and tweaked like never before. More than 8.7 million people underwent cosmetic surgery in 2003, up 33 percent from the year before, according to the American Society of Plastic Surgeons. No longer a privilege of society wives and aging starlets, cosmetic surgery has gone mainstream, available to almost anyone with a credit card and some vacation time.

Prime-time television enlightens viewers on the mechanics of liposuction and nose jobs, from MTV's I Want a Famous Face --with its pimply-faced lads who have themselves reshaped like Brad Pitt in order to get girls--to Fox's The Swan . In this 21st-century version of the 1950s sob show Queen for a Day, women compete not for a washing machine but for makeovers that include massive amounts of surgery, as well as for the chance to compete in a May 24 beauty pageant. "I wanted to look more like a woman," says Kristy Garza, 22, a contestant from Fort Irwin, Calif., who endured 9.5 hours of surgery that included a nose job, brow-lift, mid-face-lift, breast augmentation, and liposuction. "Now I turn heads. It feels so good."

Ugly ducklings?But for all the joy that plastic surgeons must be feeling about the popularity of their long-maligned craft, many also fear that shows like The Swan may be making people unrealistic, both about what surgery can accomplish and about the very real dangers of going under the knife. "The public is being lulled into the sense that there are no real risks or complications," says Rod Rohrich, a Dallas surgeon and president of the American Society of Plastic Surgeons. "We're already seeing the impact. I have patients saying they want all these things done in one operation, and you can't safely do it. It's not like buying groceries or shoes. You can take those back. You can't take your face back."

Indeed, as the number of people pursuing perfection has increased, so has the number of people injured or killed. On May 14, the state of New York fined Manhattan Eye, Ear, and Throat Hospital $20,000 for "egregious violations" in safety procedures that led to the death of two women following plastic surgery, including Olivia Goldsmith, 54, author of The First Wives' Club. In Florida, the deaths of eight patients in the past 18 months prompted officials to impose a three-month ban on combined tummy tucks and liposuction. The federal Centers for Disease Control and Prevention is now investigating 11 cases of rare, life-threatening infections after people traveled to the Dominican Republic for cut-rate cosmetic surgery. Rohrich says that half his patients are coming in to have body parts fixed, following botched surgery by someone else.

The notion that people can defy time and heredity, reshaping their bodies to suit their will, is hardly new. By the 16th century, surgeons were reshaping noses to disguise the telltale signs of syphilis. In the 1880s, surgeons lengthened Irish immigrants'"pug" noses to help them assimilate. After World War II, plastic surgeons who had honed their skills on the injured returned to help not only patients disfigured by accidents and disease but also those seeking face-lifts. Still, for most Americans, self-improvement remained a largely spiritual pursuit. In the past few decades, improved surgical techniques and new social attitudes have changed all that.

Society now puts more emphasis on looking good longer. "The system tells women they are more highly valued if they are young and thin," says Rebecca Ancheta, a San Francisco sociologist who has studied women's experiences with face-lifts. Indeed, baby boomers don't want to look the way their mothers did at 50. Nowadays, people get divorced and find themselves dating at 40, 50, 60.

People change jobs more often, too, and the competition can be 20 years younger. Even workplace demands have changed. "If you work on the assembly line at General Motors, no one cares how you look," says Lynne Luciano, an assistant professor of history at California State University and author ofLooking Good: Male Body Image in Modern America . Now the job's more likely to be in the sales department. And nobody wants to buy from a jowly guy in a size XXL T-shirt.

Yet not all people seeking cosmetic surgery are boomers desperate to reclaim lost youth. Last year, 24 percent of those getting plastic surgery were under 35. Most of those simply have a body part they'd like to change. Linda Parker had always wanted to do something about her nose. "I felt it was too big for my face, growing up. It was a honker. It had to go." Finally, at age 38, she decided to have rhinoplasty surgery, otherwise known as a "nose job." She is African-American, and worried friends asked her if she would no longer look black."That is not the case. It's not like I have a Caucasian nose. It's just a good nose for my face." Indeed, where in years past minorities may have sought cosmetic surgery to appear more white or European, surgeons say they are now doing it for the same reasons as everyone else: to look good. "It's not taboo," says Parker, an office manager in Dallas. "I even went to a popular restaurant with my little drip pad under my nose, and I didn't turn a head."

Beyond Texas.Texas leads the nation in embracing cosmetic surgery, along with New York and Florida. But even in more conservative areas like the Midwest, face-lifts and tummy tucks are becoming acceptable. "It's culturally driven," says Laurie Casas, a plastic surgeon in Glenview, Ill. "In the last five or 10 years, people have had friends or relatives who have had plastic surgery, and they have seen the positive improvements in how they feel about themselves."

Medicine has changed, too. Fifty years ago, a surgeon who performed cosmetic procedures was derided by his peers as a "beauty doc." Now eye doctors, gynecologists, ear-nose-and-throat docs, even dentists are clamoring to do Botox and breast augmentations. The reason is simple: money. Last year consumers paid $9.4 billion for cosmetic procedures, equal to about one third of the budget of the National Institutes of Health. Cosmetic surgery is one of the few medical specialties where practitioners get paid in cash up front. With insurers cutting physician payments across the board, injecting Botox at $400 a pop sounds all too alluring. Even august teaching hospitals like Johns Hopkins University Hospital are pushing cosmetic surgery as a way to subsidize money losers such as post-mastectomy breast reconstruction.

"Getting work done" is also becoming more attractive because procedures are becoming less invasive. The 2002 introduction of Botox, an injected form of botulism toxin that reduces wrinkles by temporarily paralyzing facial muscles, made it possible for people averse to surgery to try cosmetic medicine. Injectable fillers that plump out wrinkles are also increasingly popular and include old standards such as collagen and new products like hyaluronic acid (Restylane and Hylaform), a laboratory-made version of a chemical in human connective tissue. Surgeons are increasingly using a person's own fat, extracted from the abdomen or buttocks, to plump lines and recontour faces. All these fillers are temporary, lasting for a year at best. Permanent fillers that include tiny acrylic beads are being used in other countries but are a dicier proposition, since the substances can migrate, and any lumps or bumps that develop would have to be removed surgically. "People who use permanent fillers need to go in with their eyes open," says Leroy Young, a plastic surgeon in St. Louis, who notes that doctors injected liquid silicone for years before problems developed. "Permanent fillers can mean permanent problems."

Cosmetic surgeons also are adapting the minimally invasive surgical techniques used for gall bladder removal and heart valve replacements. The goal is to reduce swelling and scarring and to speed recovery. Endoscopic brow-lifts are being used to smooth the forehead through small incisions in the scalp. Surgeons overseas are already performing "feather lifts": In a traditional face-lift, the surgeon cuts loose muscle and skin and reattaches them with multiple stitches. The experimental technique threads barbed sutures under the skin through small incisions, to catch and lift sagging musculature. Surgeons using the technique say recovery takes days, as opposed to weeks with a traditional face-lift. "It's very exciting," says Peter Fodor, a Los Angeles surgeon and president of the American Society for Aesthetic Plastic Surgery. But as with all new procedures, it's unclear whether it will live up to its promise. Several years ago cosmetic surgeons were excited about Thermage, a system that uses radio frequency to tighten facial skin. But that excitement has been followed by disappointment, with only about 20 percent of patients showing big improvement.

Risks of surgery.For major transformations, surgery remains the answer. And any way you slice it, cosmetic surgery is still surgery, with all the risks that entails. Consider liposuction. This popular procedure sounds deceptively simple: Vacuum that bulge, and voil a ! But liposuction is also the most dangerous cosmetic procedure out there. Complications include clots that travel to the lungs, organ puncture, and infection, all of which can be fatal. No national tally of liposuction complications exists, but data gathered in the 1990s put the death rate as high as 20 per 100,000. By comparison, deaths from hernia or gall bladder removal average 2 per 100,000. In recent years surgeons have tried to reduce risk by limiting the amount of fat removed and other measures. A 2001 survey of surgeons found that the death rate from liposuction alone was about 2 per 100,000 procedures. But that rate soars when multiple procedures are performed. Combining liposuction with abdominoplasty (a tummy tuck) increased the risk 14-fold. "The longer the procedure, the more likely you are to have a pulmonary embolism," says Hector Vila, a Florida anesthesiologist who has studied cosmetic surgery safety.

Mona Alley learned those dangers the hard way. She had seen ads on TV for the Florida Center for Plastic Surgery, based in Fort Lauderdale, which promotes "fly in" specials. The Hollywood, Fla., woman was hoping that liposuction could eliminate her belly fat and perhaps reduce health problems associated with her Type II diabetes. When Alley, then 47, talked with surgeon John Pinnella about liposuction in November 2000, she says, "he assured me it was 100 percent fantastic for diabetes." She says the doctor also told her there would be no down time. "I was planning to be back bowling the next week." She paid $2,700 for the operation.

Alley wasn't too surprised when her stomach hurt so badly the next day that she wasn't able to go in for a postoperative checkup. But she says that two weeks later, she was so ill she couldn't walk or eat. Alley was hospitalized with a massive infection caused by a perforated intestine. She suffered blood clots, required a colostomy, and had pressure sores so big she needed skin grafts. After nine months of repeated infections and hospitalizations, both of Alley's legs were amputated above the knee. She is at home, in a wheelchair. "Look at me," she says now. "It's not all this glamour they put on TV." She is suing the physician and clinic; in court papers, the doctor denies that he was negligent in any way.

Although no surgery is without risk, patients can minimize it by doing their homework. For one thing, any physician can legally perform cosmetic procedures. "In our area there is actually a cardiologist who injects Botox," says Leroy Young. "That's where he thinks the money is."

Ask questions.The picture is further clouded by this country's diffuse regulation of medicine. The federal Food and Drug Administration oversees the safety of devices such as silicone implants. States regulate the practice of medicine. Most people are clueless about this, with three quarters of respondents in a new Harris Poll saying they thought the American Medical Association or the surgeon general regulated cosmetic surgeons. They don't. Instead, consumers need to check a physician's record with the state board of medicine and should also check with the American Board of Medical Specialties(abms.org) to make sure their doctor is board certified in his or her specialty. Few people do. "Nobody's ever asked me in 30 years if I'm board certified," says Robert Bernard, a plastic surgeon in White Plains, N.Y. "Patients should ask: Are you board certified? Where are you going to do the surgery, doc? Is your facility certified? Do you have privileges in a hospital?"

Indeed, it matters not just who's doing the surgery, but where it's taking place. More than half of all operations in the United States are now performed outside of hospitals, either at free-standing surgerycenters or in doctors' offices, because the procedures are cheaper there, and physicians often profit. But nonhospital surgery is ill-regulated, with only 22 states providing oversight. A study in last September's Archives of Surgery found that death and injury is 10 times more likely in office surgery, compared with free-standing surgery centers. Julie Rubenzer, 38, stopped breathing during breast augmentation surgery performed by Sarasota, Fla., physician Kurt Dangl in his office last September. She went into cardiac arrest and later died. State records indicate that Dangl administered anesthesia himself and that he waited five minutes after she stopped breathing before starting chest compressions. The state has placed an emergency restriction on his license.

Injuries are more likely to happen in unaccredited facilities with no qualified anesthesia provider, according to Vila. A study in this month's Plastic and Reconstructive Surgery found that if an office facility is accredited, the risk of death is no greater than that in surgery centers or hospitals. People considering surgery should make sure that the facility is accredited by the American Association for Accreditation of Ambulatory Surgery Facilities, the Accreditation Association for Ambulatory Health Care, or the Joint Commission on Accreditation of Healthcare Organizations. (Seeplasticsurgery.org, surgery.org, or yestheyrefake.net for advice.)

Jeff Harris, a 38-year-old lawyer from Dallas, had liposuction, eyelid surgery, and fat injections to smooth out his laugh lines last year. "It was alarmingly easy," he says. "It wasn't nearly as painful as I thought." Harris carefully chose a board-certified surgeon and paid for an overnight stay in the hospital because he felt it provided an extra margin of safety. "There are no blue-light specials in cosmetic surgery."

Anesthesia always poses some danger, no matter what the setting. Even the finest facilities can run into trouble. Manhattan Eye, Ear, and Throat Hospital is considered one of the best in the nation, yet the state found 10 safety violations related to the two deaths there. People with health problems such as diabetes or high blood pressure are more at risk, and even seemingly innocuous things like taking herbal supplements can cause unexpected complications. "The name of this game is vigilance," says Roger Litwiller, president of the American Society of Anesthesiologists. "If someone says he's going to have his office nurse do this, run. You only get one life."

Although this tally of perils may be more than someone eager to eliminate love handles wants to confront, the risks won't evaporate, as long as Americans'romance with surgical enhancement continues unabated. "Beauty shouldn't matter in the world, but it does," says Jeff Harris. Cosmetic surgery, he says, "is a metaphor for change."

Date: 2015-12-24; view: 766