All Those Plastic Surgery Choices Are Making Me Dizzy

Fifteen years ago I could walk down a supermarket aisle, reach for a box of my favorite crackers, toss it in my shopping cart and be off in two minutes flat. Today all that has changed. While shopping for Wheat Thins, I now am confronted by twenty-two different varieties. Do I reach for the low sodium, parmesan basil, French onion, or one of the nineteen other varieties? I study the side panel of each box to compare grams of sodium, saturated fat and calories. I evaluate each variety based on nutrition value but also personal preference.

Similarly, a generation or two ago, aesthetic plastic surgery consisted of a very short list of options: facelift (rhytidectomy), eyelid lift (eyelidplasty), and browlift (aka forehead lift), along with the occasional chemical peel or dermabrasion.

Dr. Lawrence Bass, a plastic surgeon with an active NY private practice, Director of Minimally Invasive Plastic Surgery at NYU School of Medicine and active member of the ASAPS, explains further.

Surgeons used a number of variations on these basic procedures in their individual practices and then adjusted for the specific needs of their patient, but these variations were technical surgical details rarely shared with the patients. When choices were so limited, it was rather easy for patients to focus on which procedure they wanted. The patient of the 1970's and 1980's who experienced facial droopiness or extra skin in the cheek, neck or jowl area, came to the surgeon seeking a facelift (rhytidectomy). Similarly, those with puffiness or extra eyelid skin, requested an eyelid lift (eyelidplasty), and those with a sleepy, wrinkled forehead sought a browlift.," explains Dr. Bass. "These were about the only facial rejuvenation techniques routinely available from a plastic surgeon, with an occasional cheek or chin implant to help enhance the overall aesthetic effect?"

Today all that has changed. In the past two decades we have seen an unprecedented level of innovative surgical advances and refinement of surgical techniques.

One manifestation of these advances has been a simplification of procedures, resulting in a marked decrease in surgical trauma and considerable reduction of total recovery time. Procedures were simplified to a minimum of required steps, including shorter, better-concealed incisions. Endoscopic procedures were introduced, using miniaturized instruments and a video camera attached to a long thin surgical telescope, allowing incisions for some procedures to be reduced in size or nearly eliminated.

A different type of miniaturization arrived in the form of the mini-facelift. As surgeons began to recognize that not everyone needed a total facelift, the mini-facelift emerged as the popular new kid on the block.

"Some women had not aged sufficiently to suggest the need for a full facelift, while others, who had previously undergone a cosmetic procedure, wanted only a touch-up rather than a complete overhaul, To grasp the essence of the mini-facelift technique, understand that it is identical to the full facelift but is merely confined to a more limited region of the face and typically consists of an upper or lower half of the classic facelift. For example, if the cheek is droopy, an upper mini can be performed. If the jowl or neck area is droopy, a lower mini (sometimes referred to as a necklift) can be performed. With possible minor modifications, the procedure is performed similarly to the classic facelift and provides comparable results in terms of degree and durability, while posing fewer risks, less scarring, reduced costs and more rapid recovery time.

Not simply a technical advance, Dr. Bass explains that the mini-facelift represents a philosophical recognition by surgeons and patients alike that sometimes the best result can be obtained by addressing specific features rather than remaking the entire face. Broad media exposure has further increased public awareness of these technical innovations, resulting in a substantial growth in the overall number of such procedures being performed.

In contrast to the mini-facelift, the endoscopic facelift is one which takes a fundamentally different approach than the full or classic facelift:
"Although the endoscopic procedure uses incisions which are significantly shorter and better hidden than those in the classic facelift (resulting in a reduction in the length of visible scars), the release and lift performed internally and the type of fixation for the lifted facial structures are not the same as in the full or classic facelift. The plane or level under the skin in which structures are released is different and the direction of redraping may differ as well."

Although a lot of data exists about results with classic procedures even when they are trimmed down to a smaller area, much less is known about results with novel procedures designed to minimize surgery by implementing a totally different method.

The consumer of today is being offered a dizzying array of aesthetic enhancement choices - so many that it can be positively confounding. Which ones are subtle changes from well-established practices? Which ones are breakthroughs that are likely to revolutionize the future of cosmetic surgery? Which ones have simply been renamed and touted as new to attract the attention of the gullible or uninformed? It takes real effort to sort through all the options, to separate those offering decided improvements to past practices from those that represent sound bites of advertorial hype.

Although shopping for Wheat Thins might present us with some thoughtful decision making options, selecting the right cosmetic surgery procedures is fraught with daunting challenges. Don't make the mistake of taking a go-it-alone approach. You need the advice of a skilled and ethical surgeon. Think in terms of a partnership between doctor and patient, but know that in order to partner successfully, you need to become an educated consumer. Get solid information from respected resources to help you communicate intelligently. Then listen with an open mind to the professional recommendations you are offered and engage in honest dialogue. Forget promotional ads and TV hype. More is at stake now than just shopping for crackers!