Dans Papers - June 1, 2007

Weekly magazines abound with articles on breast enlargement, liposuction or the newest facelift techniques, just as reality shows depicting plastic surgery in all its graphic glory, have become more frequent and popular, especially with the 18 to 45-year-old demographic. With close to three million surgical procedures performed in the United States in 2006, it is safe to say that cosmetic surgery is no longer the secret of the glamorous or wealthy, but a staple in the diet of a more health conscious population that simply wants to stay good-looking and young forever. So instead of another educational article on silicone implants or the weekend facelift, I would like to address the issue of excessive or overdone plastic surgery, in the hope that patients who are considering one of these procedures will rethink not only the result they seek, but how much of a change is necessary to achieve that result.

Let's start with facelifts, facial fillers and Botox. We have all seen the work done on Hollywood stars by presumably excellent surgeons, which has not only failed to restore natural beauty but has distorted a familiar face into one that is barely recognizable. I would rather hear my patient say, "Everyone thinks I look great," than, "Everyone loves the job you did." If someone knows you had a facelift, then we, as plastic surgeons, have not really done our job. A natural-looking result should leave a patient younger and refreshed without changing their facial features and certainly without telltale scars or abnormal pulling left behind.

In the same way, Botox and facial fillers should be used cautiously and conservatively to soften lines and wrinkles, not eradicate the ability to animate or respond. Barbie should be the only 60-year-old who is wrinkle free. Similarly, a fuller lip is fine if it defines and plumps the lip a little, but when the lips begin to look as if a patient has been bitten by a man-o-war, the sublime becomes the ridiculous. In short, less is more. One should look better, not different. And it is up to the patient as well as the surgeon to know when enough is enough. One sees far too many expressionless foreheads, pulled faces, mammoth cheekbones, elevated eyebrows and over-plumped lips roaming the streets.

Remember, you can always have a little more skin removed a few years down the road, or a little more filler or Botox put in a few months from now, but if too much has been done, it is often hard to reverse.

The same principles apply to breast surgery. I am seeing younger and younger patients in my practice, even some in their teens, who are unhappy with their breasts. They are too small, too droopy, too flat or too asymmetric. Many of these problems have occurred after childbirth or weight loss, but sometimes it is purely a matter of wanting larger breasts to fill out a bathing suit or special dress. For whatever reason, sociologically we have become a nation who reveres large breasts, but keep in mind the axiom that the larger the implant the greater the risk of complications and re-operation. While a surgeon can manage somehow to place a 600cc or 700cc implant into a thin A-cup woman, the appearance of rippling, malposition and a host of other problems will be that much greater. The key to a beautiful result in breast surgery is staying natural. The diameter of an implant, if used, should never be larger than the base diameter of the patient's own breast. If this means that someone starting with an A-cup might only be able to go to a full B-cup, then so be it. Trying to satisfy a patient's desire for a certain cup size or a certain volume implant is fraught with danger. Once both the patient and surgeon accept this, there will be far fewer secondary operations done to correct deformities.

I can continue and advise against excessive liposuction, fat injection, etc. but if a potential cosmetic surgery patient comes away with one point, it is that less truly is more. Seek consultation with at least two or three surgeons before deciding. Make sure the surgeon is certified by the American Board of Plastic Surgery (www.plasticsurgery.org has a list of certified plastic surgeons in your area). And by all means, stay natural!

Dr. Steven K. Palumbo is a board certified plastic surgeon. His office is located at 25 Montauk Highway, Quogue. Call (631) 653-6112 or visit www.hamptonsfacelift.com for more information.