Plastic / Cosmetic Surgery
Psychological Benefits of Plastic Surgery: They Outweigh the Health Risks
It is common knowledge that many people – especially the wealthy and the socially prominent entertainers, actors, and models – find it desirable to undergo surgery for facelifts, “nose jobs” and other kinds of and “corrective” surgery. Often it’s strictly a vanity issue. But what is not perhaps as well-known is that many people have “cosmetic” surgery for reasons that go well beyond vanity. Some have plastic surgery to eliminate severe facial deformities; some go under the knife to deal with the erosion of their self-esteem (notably HIV sufferers whose faces change with the disease); others get plastic surgery to repair a bothersome physical feature. This paper takes the position that while there are definitely risks involved in plastic surgery proceedings, in most cases the potential good that came come from the surgery is well worth the medical risk. And further, the science of corrective surgery has reached the point where the risks are minimized and the results are very worth the risks. Still, it is very important for the patient to do his or her homework prior to going into cosmetic surgery. The material presented in this paper will explain why advance research is vital.
LITERATURE REVIEW on COSMETIC SURGERY
According to an article in U.S. News & World Report, about 8.7 million Americans got “tucked, suctioned, tightened, and tweaked” (Shute, 2004) in the year 2003. That was a 33% increase from the number of Americans who underwent cosmetic or “plastic” surgery. The money spent on plastic surgery in 2003 was enormous; this article reports that over $9.4 billion was spent on this kind of surgery in 2003. And all that money spent is a good thing for surgeons, too, because when women go into surgery for breast “augmentation” or Botox treatments, or nose jobs, they pay up front.
But there are risks involved, the Shute article continues; because of TV shows that highlight the positive results of cosmetic surgery, “The public is being lulled into the sense that there are no real risks or complications,” says Rod Rohrich, who served as president of the American Society of Plastic Surgeons at the time of this article. but, Rohrich went on, some patients want several things done to improve their appearance in the same operation; it’s not safe to do that, he said. Having cosmetic surgery is not like buying groceries or buying shoes; you can take groceries and shoes back to the store but “you can’t take your face back,” said Rohrich.
There have been instances in which people undergoing plastic surgery have been injured or killed. Two women died in New York in the Manhattan Eye, Ear and Throat Hospital after undergoing plastic surgery in 2003, Shute explains; the hospital was fined $20,000 for “egregious violations” of safety procedures because of those deaths. In Florida there were eight deaths of plastic surgery patients over an 18-month period in 2003-2004; as a result, Shute continues, the health officials in Florida imposed a three-month ban on surgeries that combine liposuction and tummy tucks. What happens during cosmetic surgery that can cause death? According to this article people can and do get infections, especially when they go abroad to places like the Dominican Republic or Mexico for “cut-rate” surgery; in some foreign countries the attention to sterile, clean surgical conditions is perhaps not as great as it should be.
Liposuction has plenty of risks associated with it, Shute points out; it sounds easy and clean, in that the surgeon just vacuums the fatty bulge and bingo, the fat disappears. But there are many complications that can occur, like blood clots that can begin at the point of liposuction and travel to the lungs. Once in the lungs, it can also travel to the heart and bring about far more serious complications. Liposuction is “the most dangerous cosmetic procedure” in the entire field of elective surgery, according to Shute’s article. Liposuction can also result in the puncturing of a vital organ, and can cause infection, which sometimes leads to death.
In fact, in the 1990s the data shows that for every 100,000 patients getting liposuction procedures, roughly 20 of those patients died. During that same period of time, as a comparative example, for every 100,000 patients going under surgery for a hernia or gall bladder problem, only 2 died. Surgeons have attempted to make liposuction safer by taking out less fat during each operation. And another thing they are doing is allowing the patient to only have one thing done per surgery; for example, combining liposuction with “abdominoplasty” (which is actually a “tummy tuck”) is said to increase the risk of death 14-fold. Hector Vila, an anesthesiologist who researches the safety of plastic surgery, is quoted in the U.S. News & World Report as saying “The longer the procedure, the more likely you are to have a pulmonary embolism.”
Safety should be a big concern to people considering cosmetic surgery, and one approach to being safe, Shute says, is to “ask questions.” Before getting silicone implants in one’s breasts, for example, a woman should research the safety record of the doctor she is trusting. She can do that research because the state board of medicine in every state keeps those records, and they are part of the public record. Is the doctor board certified? That should be a main question in the minds of people planning cosmetic surgery, and yet, this article states that “few people do” ask about board certification for a particular physician. The other question that is important to ask before having surgery is – where is it to take place? This article claims that over half of all operations in the U.S. are now being done outside of hospitals; it’s cheaper to have it done in a doctor’s office, after all, and the physician can make more money. but, the problem is, “non-hospital surgery is ill-regulated,” Shute asserts in her article. Only 22 states have oversight into surgeries that take place outside of hospitals.
In the journal Prevention, the writer explains that while cosmetic surgery vacations sound tempting and even glamorous, they can be dangerous. The advertisements for cosmetic surgery vacations say you can take a safari and get a face-lift at the same time. but, this kind of vacation “…carries all the risks these procedures have at home – infection, bleeding, nerve damage, [and] anesthesia reactions” (Pouliot, 2004). Plus, there are risks from blood clots (which was mentioned earlier in this paper) that go beyond normal risks on the ground at home; that is because during air travel there are higher odds that the patient could get a blood clot. The exact title for the blood clots that could occur on a plane at 33,000 feet is called “deep vein thrombosis,” which can form in the legs and then travel up to the lungs.
Among the hundreds of thousands of Americans getting cosmetic surgery to enhance their looks – or repair birthmarks and perhaps hide other unsightly scars – are an increasing number of African-Americans. Between the years 2004 and 2005, the number of plastic surgery procedures performed on blacks in America rose from 460,531 to 768,512, according to an article in Black Enterprise (Simon, 2006). That was an increase of 67%, according to data that the author gleaned from the American Society of Plastic Surgeons. Why are so many black Americans turning to cosmetic surgery? The president of the American Society of Plastic Surgeons (who was president at the time this article was published), Bruce Cunningham, believes that blacks are more apt to go in for cosmetic surgery because there has been “a greater exposure to the benefits of plastic surgery.”
Also, Cunningham explains, there is a “growing acceptance” of the specialized kinds of plastic surgery, and added to that acceptance is an increased “economic power” within the African-American, Latino, and Asian minority groups. The number of Latinos who went for cosmetic surgery in 2005 reflected a 67% increase over the previous year, and for Asians the increase was 57%. A black plastic surgeon in Chicago, Dr. Julius Few, was quoted as saying that a few years ago blacks getting plastic surgery were looked upon by other blacks as trying to be white. The most common cosmetic surgeries among African-Americans, Simon writes, are nose reshaping, breast reductions, and liposuction. Those getting surgeries among the black community tend to be “well-educated individuals” who have the money to spend on such surgeries; and they tend to work in places where “physical presentation matters,” according to Few.
This article lists the cosmetic surgeries that were done in 2004 by ethnicity; 85% are Caucasian; 6% are Latino; 5% are African-American; 3% are Asian-American, and 1% were “other.” By 2005, the numbers changed; 77% were Caucasian; 9% were Latino; 8% African-American and 4% were Asian-Americans (2% “other”). The top five cosmetic surgical procedures by all Americans in 2005 were: Liposuction (324,000); nose reshaping (298,000); breast augmentation (291,000); eyelid surgery (231,000); and tummy tuck (135,000). Meanwhile, the top five cosmetic procedures for minorities in America in 2005 were as follows: Botox (3.8 million); “chemical peel” (1 million); “microdermabrasion” (828,000); laser hair removal (783,000); and “sclerotherapy” (590,000).
Among the various kinds of cosmetic surgery, there are several that are not at all related with vanity, but instead are corrective in nature and dealing with a serious impairment on the part of the patient. For example, an article in HIV Medicine (published by the British HIV Association) discusses facial lipoatrophy which HIV patients often are embarrassed by. The problem is a quality of life issue, and not just that a person wants to look good and acceptable. Facial lipoatrophy can cause an erosion of “self-image and self-esteem,” the article explains.
What is facial lipoatrophy? The Web site www.aidsmeds.comexplains that facial lipoatrophy (also called “facial wasting”) is not life threatening, but is “stigmatizing” and can contribute “significantly” to an HIV patient’s depression. It is believed to be a side effect of some of the anti-HIV therapies that are used on patients. Facial lipoatrophy actually refers to an “abnormal loss of body fat” right under the skin; and the most embarrassing place for this loss of fat to occur is in the face, although lipoatrophy can also show up in the legs, arms, buttocks and around the waist. An HIV patient with facial lipoatrophy suffers from sunken cheeks; the cheeks appear to be hollow, and the facial muscles can be seen and felt through the skin, the article explains on www.aidsmeds.com.
A possible remedy for facial lipoatrophy is presented in the HIV Medicine article, which reports the results of a study of the long-term safety and efficacy of “injectable poly-L-lactic acid (PLLA) to correct the sunken cheeks and hollow facial appearance. Thirty HIV patients who showed obvious signs of facial lipoatrophy agreed to undergo injections of PLLA. None of these had ever received treatment for their facial lipoatrophy. Of those patients receiving injections, some suffered from mild symptoms, some had severe symptoms; 27 of the original 30 HIV patients returned for the remainder of the study, which consisted of three sessions, two weeks apart. There was one case of infection and nine cases of “injection-site nodules.” All the patients had nodules but aside from the nine mentioned in the previous sentence, the rest of the nodules were very small. The results of the study showed that the injections did in fact help the patients’ faces retain some or much of their original fullness, but the article recommends that for future injections, a more “dilute concentration of PLLA” should be used. The thought is that to heavy a concentration of PLLA into the face caused some of the nodules to appear, although in the end of the study, none of the patients’ nodules was severe enough to cause embarrassment. The bottom line is, this kind of surgery for HIV patients is a classic example of necessary cosmetic surgery, and it brings relief to people who need help.
Another category of individuals who can justify a desire for cosmetic surgery is children with mental disabilities that have deformed faces. An article in USA Today points out that some insurance companies won’t cover plastic surgery when it involves correcting “defects of the face, skull, and neck.” The won’t cover those important surgeries because, according to the insurance companies, those are “merely cosmetic,” the article goes on, but in fact doctors and families classify those kinds of surgeries as “reconstructive and functional in nature.” The appearance of a person, especially a person with mental problems, can “positively or negatively influence his or her ability to socialize,” according to surgeon Steven Buchman, who authored a report for the American Society of Plastic Surgeons.
Children with “severe” mental disabilities “undoubtedly benefit” from plastic surgery to restore their faces to something far less unsightly; that in turn, helps the mentally retarded child “lead a fuller life,” Buchman continues in his report. When a mentally handicapped child is accepted by his or her peers parents and teachers, they learn better. Also, when a child has a physical deformity a teacher may “underestimate” the intellectual ability of that child, and hence, the teacher may have a lower expectation for the child.
Meanwhile, the most “significant advance” in facial reconstructions in the last 30 years or so is facial “transplantation,” according to an article in the Lancet (Butler, et al., 2006). Indeed, a man’s face was partially transplanted into another man’s face in France in 2005. This is extreme cosmetic surgery, and involves highly technical advances in surgery, but apparently the patient receiving a new face has healed quickly, has experienced “gradual recovery of function” along with psychological acceptance of the graft after twelve weeks. This is worth mentioning for this paper because it is an example of how far medical science has come in the past few years. There are risks in partial facial transplants, the authors indicate, but the next step is to “identify the potential risks,” and development strategies to minimize those risks.
Aids / Meds. “Changes to Your Face (facial lipoatrophy).” Retrieved July 23, 2007, at http://www.aidsmeds.com/articles/lipoatrophy_4794.shtml.
Butler, Peter E.M. “Managing the risks of facial transplantation.” The Lancet Vol. 368 (2006):
Moyle, G.J.; Brown, S.; Lysakova, L.; & Barton, S.E. “Long-term safety ad efficacy of poly-L-
Lactic acid in the treatment of HIV-related facial lipoatrophy.” HIV Medicine / British HIV
Association Vol. 7 (2006): 181-185.
Pouliot, Janine S. “New Vacation Souvenir: A Face-Lift.” Prevention 56.8 (2004): 38-38.
Simon, Mashdaun D. “More Blacks Getting Nipped and Tucked.” Black Enterprise 37.4 (2006):
Shute, Nancy. “Makeover Nation.” U.S. News & World Report. 136.19 (2004): 52-63.
USA Today. “Why People Want Plastic Surgery.” 134.2725 (2005): 2-2.
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