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Thinking Plastic

"I call him my maintenance man," says a 39-year-old Naples financial executive of the plastic surgeon who performed her liposuction and breast augmentation nearly a year ago. Once the exclusive province of the Hollywood elite, cosmetic surgery is moving into the mainstream as an acceptable form of self-improvement.

"Plastic surgery is one of many pieces of a puzzle that includes good health and nutrition, exercise and health care," says Dr. Michael Gross of the Plastic Surgery Center of Southwest Florida in Bonita Springs. Surgical procedures are now safer and easier thanks to advances like endoscopy, which requires fewer and smaller incisions, and thus causes less scarring. Better results plus less risk add up to greater appeal to prospective patients.

And the costs-from about $800 for a chemical peel to upward of $15,000 for a full face-lift--can now seem less daunting with the advent of finance companies formed especially with elective surgical procedures in mind. You can take out a loan on your new nose, for example, and pay it off over time.

All these factors have contributed to the field's increased popularity. The American Society of Plastic Surgeons reports that the number of people having cosmetic plastic surgery has tripled since 1992. While most patients are still women, local doctors report that more men are showing up in their offices as well. For many types of surgery, age can run from the 20s on up. Dr. Mark Prysi of Prysi Cosmetic Surgery in Naples reports that he's done five face-lifts on women in their 80s in the past six months.

Before you head right for your local plastic surgeon, you should know a few facts about choices, risks, likely results and the homework you need to do before selecting a doctor.

Before the Procedure

As with any surgery, there are risks involved, and preparations you should make to minimize them. Luckily, according to Gross, "the major-complication rate is very low in plastic surgery," partly because of ever-improving technology and partly because "you're usually choosing healthy patients on whom to operate."

General risks include bleeding, infection, nerve damage, shock and embolism. General anesthesia, if involved, always carries the risk of death. But Dr. Nalin Master of Cosmetic Surgeons of Naples estimates that these complications occur less than one percent of the time.

In order to keep risks to a minimum, patients are advised (but not required by most surgeons) to have a checkup by their primary physician prior to surgery to make sure they are in good general health. Smokers should quit two to three weeks before surgery, and should continue to abstain for several weeks after, to minimize risk of excessive bleeding. Your surgeon will go over other specific preparations that need to be made.

Local Favorites

It seems there are as many plastic surgery procedures as there are parts of the body, but of the many available, a handful emerge as the most popular locally.

Body Sculpting

You've dieted off those extra pounds; you've exercised until you feel the burn-but still there are parts of your body that don't show the results. . When all else has failed, plastic surgery can sometimes seem to work miracles. One of the most popular of all procedures in recent years has been liposuction ($2,500 and up). "Your personal trainer may tell you that spot reduction isn't possible, which is true in a gym," says Dr. Bill Eshbaugh of South Florida Plastic Surgery in Bonita Springs. "But with lipo, spot reduction is possible."

Liposuction, the removal of fat, can be performed under local anesthesia in a doctor's office, or in a hospital or surgical center under general anesthesia, depending upon how much fat is to be removed. It's a common surgery with all age groups and both sexes-though more predominantly women-and is often performed in conjunction with other surgeries such as abdomenoplasties (tummy tucks), where loose or excess skin is also involved.

Post-surgery, patients may experience some bruising for three to four weeks, and swelling for up to a couple of months. Scars are small and minimal, and usually hidden in areas like the groin and knees. Pain medications are generally prescribed, and special compression garments are recommended for the first few weeks, but true downtime is minimal. A patient may undergo the surgery on Thursday and be back at work on Monday.

Lipo is not a treatment for obesity, surgeons warn, and the procedure should be undertaken as part of a healthy diet and exercise regimen. Results can be permanent depending upon a patient's lifestyle. A tummy tuck, the frequent companion to liposuction, can tighten up loose abdominal muscles and remove stretch marks. It requires up to two to three weeks of down time, with sports and heavy activity limited for six to eight weeks.

Breast surgeries

These fall into four categories: breast enlargement, breast reduction, breast reconstruction and breast lifts ($4,000 to $7,500). All re-form or reshape the breast into the desired shape and size, depending on the procedure.

Incisions are generally in the natural fold under the breast, under the arm, or below the nipple, to minimize visibility, so scarring is unobtrusive. Risks for implants include capsular contracture, which makes the breasts feel hard to the touch, and, with silicone (banned by the federal government in 1992 but now available on a limited basis for special studies), rupture and leakage into the body.

Dressings may be worn for two to three weeks, and sutures are generally removed within two weeks. Strenuous activity is discouraged for the first four to six weeks, though patients may be up and around fairly soon.

Breast reconstruction can be covered by insurance, as can breast reduction in cases where the patient experiences health complications from the excess weight, such as neck and shoulder problems, or infection of the area beneath the breasts.

"I always felt like I was missing something as a woman," says one local breast-augmentation patient. "When I did it, it absolutely made me feel great about myself. I wish I'd done it sooner."

Facial Procedures/Skin Care

The face is the first thing most people notice about someone, and more people are turning to cosmetic surgery to pick up the slack where nature falls short. "In this society, looks can be a factor in one's professional and personal life," says Eshbaugh.

Face and neck lifts ($5,000 to $15,000) are cited by many local surgeons as among their most popular surgeries. Prysi, who specializes in the relatively new vertical endoscopic face-lifts, estimates that they constitute 85 percent of his procedures. In this type of procedure, small incisions are made near the temples and hairline, and the tissue is lifted straight up, as opposed to traditional face-lifts, in which layers of skin are pulled toward the ears. The result is a more youthful, rested, natural look, as opposed to what Prysi terms the "windswept" look of old-fashioned face-lifts. "We like to view it as turning back the clock," says Eshbaugh, "and you age normally from there."

Recovery is generally quicker as well, with less bruising and fewer incisions. Bandages are generally removed within a few days, and sutures within a week to 10 days. Bruising may appear for several weeks, though makeup can generally be worn after a week or so.

Eyelid surgery, or blepharoplasty ($3,000 to $5,000), can include the minimizing of bags and wrinkles below the eye, as well as the removal of excess skin and fat in the upper eyelid that can lead to a droopy-eyed look. "In my practice, we think the eyes are the windows to the face," says Dr. Nalin Master of Cosmetic Surgeons of Naples. Often, this surgery alone can restore a more vital, rested, youthful appearance to the face, he says, though it is frequently combined with other procedures. Mild pain medications and cold compresses are prescribed for the first few days; sutures dissolve in five to seven days, and bruising may last up to three weeks.

Laser resurfacing and chemical peel dermabrasion ($800 to $5,500) both remove the outer layers of skin on the face, revealing newer, more youthful-looking skin beneath. The procedure can also offer some tightening of the collagen to smooth wrinkles and can minimize uneven facial skin pigmentation. Laser surgery involves thermal burns, while a chemical peel, as its name implies, burns the skin chemically. Both are popular and comparably priced; laser, the newer procedure, seems to be gaining in popularity, perhaps due to its greater precision and more controllable results. Milder versions can be performed in office in a series of visits that leave a patient looking only slightly red and immediately socially presentable. Deeper techniques involve anesthesia and result in what Eshbaugh likens to having a second-degree sunburn.

Recovery , depending upon the depth of the procedure, takes from five to seven days to up to two weeks. "I would say it's more uncomfortable than painful," says a 56-year-old Naples resident who underwent laser skin resurfacing last January.

Rhinoplasty ($5,500 to $7,500), commonly called a nose job, is a surgery in which the nose is reshaped. Depending upon the patient, the nose may be broken, or simply reshaped. The procedure can be performed under local or general anesthesia on an outpatient basis. Most often all incisions are concealed inside the nose, so scarring is usually invisible. Packing may be necessary for the first few days; a splint is worn for the first five to six days, though the patient may be up and about as soon as the following day if no strenuous activities are attempted. Most bruising and swelling will subside within two to three weeks, although some subtle residual swelling may take up to a year to disappear.

Choosing a Surgeon

Selecting a surgeon is as important as selecting your surgery. Botched surgeries are rare, but they can happen.. Be sure to ask lots of questions when considering any kind of cosmetic surgery.

Most important: The doctor should be certified by the American Board of Plastic Surgeons, the only certifying board for cosmetic surgeons, regulated by the American Board of Medical Specialties. A quick visit to the American Society of Plastic Surgeons Web site, www.plasticsurgery.org, will let you know if your doctor is certified, if you prefer not to ask outright. (The site also has a wealth of other resources, from detailed information on procedures to the latest research.)

Second, you should ask to see before-and-after pictures of former patients, particularly those who have had the procedureyou are considering. Remember that the photos you are shown likely represent the surgeon's best work.

Ask about a surgeon's education, training and experience. Has the doctor performed a good number of your type of surgery? Did he study with experts in that procedure? Does the doctor have hospital privileges in the area? (Hospitals have among the most stringent requirements in granting such privileges, so if a surgeon has them, you can be fairly confident of his qualifications.) Can you talk to a few of the doctor's previous patients about their experience?

Finally, are you comfortable with the surgeon? Does he listen? Is his staff helpful, supportive and available? Remember that even though this is elective surgery, it is invasive and does carry risks. Take every precaution to ensure your safety and satisfactory results

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