Plastic Surgery Choices

Last Editorial Review: 10/4/2004

WebMD Live Events Transcript

Now more common than ever, cosmetic surgery has become an option for people of many different ages with many different reasons for considering a procedure. We discussed what you need to know about changing, repairing, or rebuilding with plastic surgery when James Zins, MD, was our guest on Aug. 11, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome, Dr. Zins. What should we look for when choosing a plastic surgeon?

ZINS:
Well, I think that's a very important question, and one that should be researched thoroughly. This is an important relationship and a serious one. I think that you should feel comfortable with the plastic surgeon you choose, and feel that you can communicate your concerns with the surgeon comfortably. There are some very good tips that I can give you in making this selection.

First, the plastic surgeon should be board certified by the American Board of Plastic Surgery. There are a number of other surgical specialties that do cosmetic surgery; however, board certification by the American Board of Plastic Surgery will make certain that your plastic surgeon is best qualified in a wide variety of cosmetic and reconstructive procedures.

In addition, word of mouth and standing in the community are extremely important. A plastic surgeon that is generally respected for his or her work will be so recognized by individuals in the community. If you have had friends or family members who have had a good experience with a plastic surgeon who has done a similar procedure in which you are interested, this is also very helpful.

In interviewing the plastic surgeon, and I think an interview is essential, there are certain questions that I think are important to ask such as:

  • How many operations of a given procedure does that plastic surgeon do in a year? If the plastic surgeon does a large number, it's much more likely that he will be adept at that procedure.
  • I would also be very specific and ask the plastic surgeon how many surgeries of a given procedure that he does; that is, the specific procedure that you are interested in.
Finally, you should come out of the conference and interview with a feeling of confidence and positive feelings about your surgeon before undertaking the procedure.

MEMBER QUESTION:
Please comment on tummy tucks (partial or full), and/or liposuction of the tummy. How effective, how involved is the procedure, downtime, pain, cost. Who is the best CCF doctor to do the procedure?

ZINS:
What you are asking is what are the best procedures for what we call body contouring. In the abdomen these procedures fall into two categories.

First, liposuction is an excellent procedure for the right candidates, but these candidates need to be carefully screened. The ideal candidate for liposuction is a patient with good skin elasticity and one who is of relatively normal body weight. This generally means that the patient is in his or her 20s, 30s, or 40s, and has no stretch marks and no overhanging skin. While patients who are not ideal candidates may also undergo liposuction, compromises in the ideal result need to be accepted.

Liposuction recovery is generally uneventful and relatively rapid. The patient may be sore for several days to perhaps a week. Complications in well-selected patients are infrequent and are generally related to under removal or over removal of fat.

The next procedure, abdominoplasty, is generally performed in women after child bearing or in middle age and sometimes later. While liposuction requires small incisions, abdominoplasty requires longer ones, and this length of incision depends on the amount of tissue or excess skin the patient may have. Therefore, the abdominoplasty may be accomplished through a relatively short incision in patients who have predominantly loose muscle after children, or it may require a very long incision from above the pubis virtually all around to the back for patients who have a large amount of excess skin. An example of this type of patient would be one who lost 100 pounds or more.

In abdominoplasty, extra skin, extra fat, and loose muscle can be treated. This is characteristic of a middle-aged woman after she has had several children. Liposuction, on the other hand, removes fat only, and the skin must be elastic enough to contract on its own.

Cost varies with the degree of complexity of the operation. Miniabdominoplasty will cost perhaps $3,500, whereas an abdominoplasty, which extends almost to the back (incidentally, this is called a circumferential abdominoplasty) will cost much more, in the range of $7,500. These prices vary from surgeon to surgeon and from location to location in the United Sates.

At The Cleveland Clinic we have five plastic surgeons that are adept at this type of surgery. We would be happy to discuss the surgeons with you over the telephone. You could also visit our web site for a bio of each surgeon.

In general, for any of these cosmetic procedures, weight loss prior to surgery is preferred to weight loss after surgery. That's true for any plastic surgery procedure, cosmetic or plastic. That's a general recommendation for any cosmetic or reconstructive procedure, weight loss first. The reason that is preferred in an abdominoplasty or face-lift is that the weight loss may create additional loose skin that could be removed at the time of the procedure, whereas weight loss after surgery would create loose skin in the postoperative period, and have negative effects on the surgical results. Now, when we talk about weight loss, however, I'm talking about significant weight loss. I would be talking about 15 pounds or more.

"In general, for any of these cosmetic procedures, weight loss prior to surgery is preferred to weight loss after surgery. That's true for any plastic surgery procedure, cosmetic or plastic."

MEMBER QUESTION:
When do you have complete healing with breast augmentation?

ZINS:
It depends on what exactly we mean by complete healing. And by this I mean within several weeks most patients are reasonably comfortable after breast augmentation. They may have minor discomfort at this time, but certainly in two to four weeks they should be resuming normal activity.

However, if the patient develops firmness of the breast this can lead to discomfort relatively long after the procedure. Therefore, if the patient has continued discomfort months or even several years after surgery, he or she should return to see their surgeon. Firmness of the breast, or capsules, can result months or even years after surgery. Therefore, if an individual has the gradual onset of new discomfort, months or years after surgery, I would recommend that they return to see their surgeon.

MEMBER QUESTION:
Could you go into some detail about removing dark bags from under eyes?

ZINS:
Well, of course I would have to see the patient to understand certain specifics. But, generally bags under the eyes are due to one or a combination of several things:
  • Excess fat
  • Excess fat combined with lax or excess muscle
  • Excess skin
  • Darkness under the eyes can be the result of sun damage or can be an inherited type of abnormality

Darkening under the eyes can first be treated by products used at home, such as Retin-A or Retin-A in combination with bleaching creams. If this is unsuccessful, a variety of peeling techniques can be used to remove pigment.

MEMBER QUESTION:
Four years ago I had a chondrosarcoma on my shoulder blade and as a result had a total scapulectomy. Since having this surgery I have experienced a tremendous pull and drag effect on my left breast (which also happens to be two sizes larger than the right breast). I realize I no longer have the support that I previously had. My question and theory is this: If I reduce the size of my left breast with reduction surgery will this in turn reduce the heaviness that I am experiencing on the left side? I would be eternally grateful if you could provide me with your opinion.

ZINS:
Certainly large breasts cause patients a number of problems. These include back pain, strap mark grooves, infections under the breasts, as well as neck pain. However, pain is a very subjective thing. If your breast size is a D cup or greater then reduction in the size of the breast may well have a positive effect on the pulling or discomfort you're describing. This may or may not be related to your previous surgery, but I would suggest that you return to your surgeon if the scapulectomy problem is an issue.

"Certain growths can be readily removed by superficial techniques that require superficial removal only with a minimum scar."

MEMBER QUESTION:
I would like to remove two moles from my face for purely cosmetic reasons. One is in an obvious spot and I want to minimize scarring and discoloration. The moles are raised (one on my cheek and the other by my temple/hairline) and approximately the diameter of a pen cap. Do you recommend I see a dermatologist or a plastic surgeon for this type of procedure? Is scraping, cutting, or freezing best? Also, can you give a general guideline of the cost of such a procedure?

ZINS:
My prejudice would be that for any cosmetic result a plastic surgeon is the best person to see, because of his or her attention to surgical detail. Of course, there are good dermatologists who remove moles, and if other friends or family members have had a good experience with a dermatologist, this would be acceptable. However, in general, plastic surgeons are technically superior in surgical techniques.

The mole would need to be examined to determine the best method of removal and removal with a minimum scar. Certain growths can be readily removed by superficial techniques that require superficial removal only with a minimum scar. Other growths require an excision or scar for complete removal.

Cost is dictated by the size of the lesion, the number to be removed, and the surgical technique required for their removal. Because of this, specific prices would be difficult to give you without more detail.

MEMBER QUESTION:
Please give me your opinion on the effectiveness of Thermage versus eyelid surgery.

ZINS:
Of course I need to talk in generalities when not being able to examine the patient. Eyelid surgery is done for a number of reasons. Most commonly, in the upper eyelids the problem is predominantly excess skin, and sometimes excess skin and fat. This is so readily treated by surgery and the result so consistent I would be hard pressed to even consider any other technique.

In the lower eyelids, the problem is generally fat visibility, excess fat, lax cover of the fat so the fat is prominent, and sometimes loose muscle or excess skin. Again, these problems are most effectively treated by eyelid surgery and Thermage would be ill advised. Thermage has been most successful in the forehead and to some degree in the cheek area, although these results are inconsistent. Therefore, I would approach Thermage with significant circumspection.

MEMBER QUESTION:
How risky is it to remove cheek implants that were inserted 12 years ago?

ZINS:
I would first ask why the person would like the implants removed. Are they malpositioned? Are they too big? Do they appear to be enhancing the appearance? If there is a problem with the implants, then removal would be reasonable.

Cheek implants can be placed initially through a number of incisions and sometimes are fixed in place with screws, making their removal more difficult. Therefore, before they were removed, I would suggest that the patient obtain the operative report from his or her previous implant operation. If the implants were not fixed with screws, removal is generally uncomplicated. But the patient should understand that he or she would lose the effect that the operation has created on their appearance.

MEMBER QUESTION:
I can't let my job know about having eyelid surgery. How long after will a person be bruised?

ZINS:
That varies according to the type of operation, the complexity of the operation, which eyelids are being operated on, upper eyelids or lower eyelids, and whether anything else is being done at the same time. Generally, patients' black and blues will be able to be concealed at 10 days to two weeks after surgery.

MEMBER QUESTION:
Is there a procedure to broaden shoulders?

ZINS:
Not that I know of. Anything's possible.

MEMBER QUESTION:
I have a question about a 2"- to 3"-long scar on my face that is 40 years old. I had eight stitches on my cheek, but the wound got infected several times. The scar is dimpled. Is it possible to have it repaired or made less obvious, even though I've had it so long?

ZINS:
Anything's possible. Without seeing you it is possible to review the scar; however, scar revision turns the clock back and the scar initially, over the next several months, will be visible. Scars that are many years old tend to be much fainter, but if there is a significant indentation, pucker, or other irregularity, consulting a plastic surgeon for correction is quite reasonable.

MEMBER QUESTION:
I was told that if you have a face-lift that nothing can be done with the neck. And that is why you see women all wearing turtlenecks. Is this true?

ZINS:
This is totally untrue, and the source of information is not well informed. Actually, virtually anytime that I do a face-lift the neck is also treated. In general, with regards to aging, the neck is often the first area to age. In fact, isolated treatment of the neck only, through incisions under the chin or through incisions that we use for a face-lift, is frequently utilized.

In the case of a revision face-lift, that is, in a patient who's had a face-lift and is undergoing another face-lift years later, often the neck has held up better than most other areas of the face. In short, the neck is an ideal area to treat to improve or reverse aging.

"There's been tremendous amount of media attention on plastic surgery in general, and cosmetic surgery in particular. The potential negative effect of this attention is to trivialize the importance and the seriousness of these operations."

MEMBER QUESTION:
I get skin tags on my eyelids, my neck, under my arms, on my back, and worst of all, on my upper inner thighs. If I get them removed, will they just grow back? I know my family doctor can cut them off, but I don't want her cutting near my eyes, and she doesn't feel they are medically necessary to remove, so I might as well see a plastic surgeon since she thinks my concerns are purely cosmetic, even though they can be irritated (especially on my thighs). Your advice, please?

ZINS:
Skin tags are readily removed in any location by a most simple procedure, and eyelids would pose no problem. The skin tags shouldn't return, but if you have formed many skin tags previously, you may form some more.

MODERATOR:
Are there any special concerns for those with darker skin when considering plastic surgery?

ZINS:
Darker-skin people have a tendency to form thicker scars, although this is unusual in the eyelid area. There are also techniques in properly selected patients who can have the surgery done without a skin incision and rather an incision in the conjunctivi, or inside the eyelid. This incision is generally used in patients who have fat excess in the lower lids only and minimal excess skin.

MODERATOR:
Dr. Zins, before we wrap things up, do you have any final words for us?

ZINS:
I think perhaps the best question we had today was your first question on how to choose a plastic surgeon. There's been tremendous amount of media attention on plastic surgery in general, and cosmetic surgery in particular. The potential negative effect of this attention is to trivialize the importance and the seriousness of these operations. Therefore, choosing the best-qualified person to do your surgery is the most important decision that you'll make with regard to a cosmetic surgery procedure.

Plastic surgery is a very diverse field, and good plastic surgeons may perform many operations well but not necessarily all operations well; therefore, the experience of your surgeon with the specific problem with which you are dealing is most important.

MODERATOR:
Our thanks to James Zins, MD, the chairman of the department of plastic surgery at The Cleveland Clinic, for sharing his expertise with us.

©1996-2005 WebMD Inc. All rights reserved.

SLIDESHOW

Plastic Surgery: Before and After Photos of Cosmetic Surgeries See Slideshow

Health Solutions From Our Sponsors