Makeover Nation
Americans are opting for cosmetic surgery in record numbers. But do they know the risks?
Beyond Texas. Texas leads the nation in embracing cosmetic surgery, along with New York and Florida. But even in more conservative areas like the Midwest, face-lifts and tummy tucks are becoming acceptable. "It's culturally driven," says Laurie Casas, a plastic surgeon in Glenview, Ill. "In the last five or 10 years, people have had friends or relatives who have had plastic surgery, and they have seen the positive improvements in how they feel about themselves."
Medicine has changed, too. Fifty years ago, a surgeon who performed cosmetic procedures was derided by his peers as a "beauty doc." Now eye doctors, gynecologists, ear-nose-and-throat docs, even dentists are clamoring to do Botox and breast augmentations. The reason is simple: money. Last year consumers paid $9.4 billion for cosmetic procedures, equal to about one third of the budget of the National Institutes of Health. Cosmetic surgery is one of the few medical specialties where practitioners get paid in cash up front. With insurers cutting physician payments across the board, injecting Botox at $400 a pop sounds all too alluring. Even august teaching hospitals like Johns Hopkins University Hospital are pushing cosmetic surgery as a way to subsidize money losers such as post-mastectomy breast reconstruction.
"Getting work done" is also becoming more attractive because procedures are becoming less invasive. The 2002 introduction of Botox, an injected form of botulism toxin that reduces wrinkles by temporarily paralyzing facial muscles, made it possible for people averse to surgery to try cosmetic medicine. Injectable fillers that plump out wrinkles are also increasingly popular and include old standards such as collagen and new products like hyaluronic acid (Restylane and Hylaform), a laboratory-made version of a chemical in human connective tissue. Surgeons are increasingly using a person's own fat, extracted from the abdomen or buttocks, to plump lines and recontour faces. All these fillers are temporary, lasting for a year at best. Permanent fillers that include tiny acrylic beads are being used in other countries but are a dicier proposition, since the substances can migrate, and any lumps or bumps that develop would have to be removed surgically. "People who use permanent fillers need to go in with their eyes open," says Leroy Young, a plastic surgeon in St. Louis, who notes that doctors injected liquid silicone for years before problems developed. "Permanent fillers can mean permanent problems."
Cosmetic surgeons also are adapting the minimally invasive surgical techniques used for gall bladder removal and heart valve replacements. The goal is to reduce swelling and scarring and to speed recovery. Endoscopic brow-lifts are being used to smooth the forehead through small incisions in the scalp. Surgeons overseas are already performing "feather lifts": In a traditional face-lift, the surgeon cuts loose muscle and skin and reattaches them with multiple stitches. The experimental technique threads barbed sutures under the skin through small incisions, to catch and lift sagging musculature. Surgeons using the technique say recovery takes days, as opposed to weeks with a traditional face-lift. "It's very exciting," says Peter Fodor, a Los Angeles surgeon and president of the American Society for Aesthetic Plastic Surgery. But as with all new procedures, it's unclear whether it will live up to its promise. Several years ago cosmetic surgeons were excited about Thermage, a system that uses radio frequency to tighten facial skin. But that excitement has been followed by disappointment, with only about 20 percent of patients showing big improvement.
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