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Using a Surgeon's Tools to Erase the Years

It's called plastic surgery, but there's no plastic involved. In this case, plastic refers to the ability of the surgeon to reshape the skin, the face, or other body parts. With advances in technique and an aging population, plastic surgery is more popular than ever.

Plastic surgery is divided into cosmetic procedures, or those done strictly for "looks," and reconstructive procedures, or those done after an injury or illness affects structure or skin. The procedures listed below generally fall into the cosmetic realm, and as such, are usually not covered by health insurance. Be sure to check with your surgeon or insurance plan before scheduling a procedure.

According to the American Society of Plastic Surgeons (ASPS), the top five nonsurgical cosmetic procedures are Botox injections, chemical peel, laser hair removal, microdermabrasion, and hyaluronic acid. They range in average price from about $260 for microdermabrasion to nearly $700 for a chemical peel. The top five surgical cosmetic procedures are breast implants, nose reshaping, liposuction, eyelid surgery, and tummy tuck. They range in average price from about $3,000 for liposuction to about $5,000 to $6,000 for a tummy tuck. Most of the procedures can be done as an outpatient, and most do not require a hospital stay.

Before signing up for any cosmetic?or other?procedure, it's important to be realistic about the outcome of the surgery. Like any surgery, plastic surgery carries certain risks, including infection. You also should be in good health to undergo a procedure. A cosmetic procedure won't guarantee you fame or happiness. It can help you feel better about yourself, however, and that can change your life.

Face

Wrinkles, lines, age spots?the face is where the signs of aging seem most obvious. Most of the cosmetic procedures focus on the face and range from minimally invasive injections that smooth wrinkles to facial implants, which dramatically change the shape of the face. Most of the procedures require extra protection from the sun?at least temporarily, during recovery.

Chemical peel

This procedure applies one of several chemicals to the skin, causing the top layers to peel away and leaving the smoother lower layers in place. Glycolic acid and trichloroacetic acid are two chemicals that can be used. Although this procedure removes wrinkles, it won't stop new wrinkles from forming, nor will it do anything for sagging skin. People who may not be good candidates for a chemical peel include those with allergies, a history of being burned, scars that don't heal well, or radiation exposure, the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) says.

Peels may take several hours. You may feel tingling, swelling, or throbbing on your face afterward. The procedure may trigger skin allergies, fever blisters, or cold sores. You can resume your usual activities within two to four weeks, but your skin will take up to six months to heal fully.

Injections 

Soft tissue or fat injected beneath the skin adds plumpness and eases wrinkles. Thin, light-colored skin works best for this procedure, the ASPS says. Injections may be of collagen, fat, hyaluronic acid, hydroxylapatite acid, or botulinum toxin (Botox). Botox is injected in tiny amounts, and causes the muscles around the injection to relax.

The injections are given at the doctor's office. The results are only temporary and must be repeated after a few months to a year. The only side effects of the collagen or hyaluronic acid are a burning or throbbing feeling that goes away. Botox side effects may include droopy eyelids, flu symptoms, headache, and stomach upset.

Dermabrasion

This procedure is used for deeper wrinkles, as well as to smooth acne scars and wrinkles around the mouth. After numbing the skin, the surgeon uses a high-speed rotating brush to remove the top layers of skin. Like the chemical peel, dermabrasion will not prevent wrinkles or tighten sagging skin.

Dermabrasion usually takes less than an hour. It may trigger skin allergies, fever blisters, or cold sores, the ASPS says. Your skin will be red after the procedure, but that will diminish in about a month. You'll need to use sunscreen whenever you are outdoors for about a year. You may need to eat soft foods for the first few weeks and avoid activities that could stress the skin, the AAFPRS says.

Laser resurfacing

A carbon dioxide laser is used to vaporize the outer layer of skin on the face, removing lines, wrinkles, and acne scarring. This procedure may take up to an hour to complete. You may have some swelling afterward, and your skin may remain pink or reddish for up to six months, the ASPS says. Most people are very sensitive to the sun after this procedure, as well as more sensitive to makeup. Laser resurfacing will not stop future wrinkling of the skin.

Facelift

This is the stereotypical cosmetic surgery procedure, in which sagging skin on the face and neck is repositioned. A facelift usually takes several hours. Afterward, the skin may feel dry or tight, and men who have the procedure may need to shave behind their ears, where facial skin is moved, the ASPS says. The results usually last five to 10 years.

Forehead or brow lift

This "lift" procedure focuses on the forehead to reduce creases and frown lines, as well as drooping eyebrows. The surgeon can make incisions at or behind the hairline or use an endoscope to make a few small incisions?which leaves less scarring. The procedure takes one to two hours, with recovery in seven to 10 days. Swelling and bruising are common just after the surgery, the AAFPRS says. The results are the same as for a facelift: They last five to 10 years.

Facial implant

For a person who wants or needs to change the shape of the chin, cheekbones, or jaw line, the surgeon can use implants. A facial implant generally takes from a half hour to two hours. Swelling, bruising, and numbness are temporary side effects; for jaw surgery, you may not be able to open your mouth for several weeks, the ASPS says. The results are permanent.

Breast

Plastic surgery can increase or reduce the size of breasts or reshape breasts that sag by using augmentation, lift, or reduction. For men with extra breast tissue, surgery can reduce the size of the breast area. For women, breast reduction can also relieve the discomfort associated with overly large breasts.

Breast augmentation

In this procedure, an implant called a shell and filled with saline or silicon is placed in the breast to increase breast size. The surgery typically lasts one to two hours, with swelling, bruising, and soreness as temporary side effects. One drawback to breast implants is their impermanence. Ruptures, deflations, and other complications can require the implant to be removed. Depending on how the implant is inserted, a woman may have difficulty breastfeeding. The implant may make it difficult to get an accurate mammogram, or the implant may rupture when the breast is compressed during mammography,There has been no proven link between breast implants and autoimmune disease or other systemic diseases. 

Breast lift

Like other "lift" surgeries, this one aims to reduce sagging. In a procedure that lasts from one to three hours, the plastic surgeon raises the breasts by getting rid of excess skin, the ASPS says. Aside from temporary swelling and bruising, long-term effects may be scars and loss of feeling in the breast and nipple. How long the lift lasts depends on age, weight changes, and pregnancy.

Breast reduction

For women, this procedure is also called reduction mammoplasty. Women with overly large breasts are excellent candidates as it removes excess breast fat, glandular tissue, and skin to achieve a breast size proportionate to the body.

For men who have excess breast tissue, the plastic surgeon uses liposuction or surgery to reduce it. The procedure takes at least an hour, and the results are permanent (although additional surgery may be needed to remove more tissue), the ASPS says.

Ears

A child with prominent ears?those that stick out more than four-fifths inch from the head?may have corrective surgery called otoplasty. The surgery is usually done when the child is age 5 or 6, when the ears have reached their full size, but it may also be done on older children and adults, according to the American Academy of Otolaryngology-Head and Neck Surgery. The procedure takes two to three hours, and the results are usually permanent. Ears may also be reduced in size or reshaped, if needed.

Eyes

The area below the eyes can develop puffy bags and the upper eyelids can start to droop with age. A procedure called blepharoplasty can correct these problems?but not dark circles or fine lines around the eyes, the AAFPRS says. Blepharoplasty typically takes one to two hours, with the results lasting several years. During recovery, you may need to use eyedrops or eye ointment to keep the eyes moistened. You may have temporary blurred or double vision.

Nose

A "nose job" is called rhinoplasty, in which the surgeon reshapes the nose. This is often a cosmetic procedure?to reduce or to increase the size of the nose, or change the shape of the tip or nostrils?but it also can be reconstructive when it is needed to relieve breathing problems. The procedure takes at least one to two hours, and the results are permanent. You won't be able to blow your nose for several days after the surgery, and your face will be puffy for a day or two.

Abdomen

Plastic surgery offers two options for an abdomen that's padded with extra fat: liposuction or a tummy tuck. Most medical insurance will not pay for these procedures, however, and the cost can be quite steep?up to $5,000, the ASPS says. Keep in mind that you have another option that's far less expensive: You can lose weight, reducing the amount of excess fat.

Liposuction

The plastic surgeon uses one of two techniques to suction out fat deposits: the tumescent technique, in which a saline solution is applied to fat cells, and ultrasound-assisted lipoplasty, in which ultrasound is directed at the fat cells to make them easier to remove, the ASPS says. Liposuction can also be done elsewhere on the body, including the buttocks, hips, thighs, upper arms, and face. Liposuction takes several hours, with the ultrasound method taking longer than the tumescent method. With a healthy diet and exercise, the results can be permanent. The areas where the liposuction device was inserted may drain fluids for several days after the procedure. You also may need to wear special tight-fitting clothing for several weeks to keep your skin compressed.

Tummy tuck

This procedure removes excess fat and skin, and in most cases, tightens the abdominal wall muscles, the ASPS says. It takes two to five hours, and can be permanent if you eat sensibly and get regular exercise to keep your weight under control. Risks include the need for additional surgery, scarring, and poor healing.

Hair

Men with male pattern baldness can have hair replacement surgery, in which hair from the side or back of the scalp fills in the bald patches. The bald areas can be covered in several ways, the ASPS says: by reducing the bald area of the scalp, or by attaching strips or clusters of hair. The process is usually accomplished through several sessions spaced at least four months apart to allow for healing. Each session may last one to three hours. Hair replacement surgery is more successful if a man waits until he has stopped losing hair. The results are more natural with light-colored or coarse hair than with dark or fine hair, the AAFPRS says. The surgery is impossible if a man is totally bald.

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