Tinkering with Mother Nature

Tinkering with Mother Nature

Facial implants and chemical peels have joined tummy tucks and nose jobs in the panoply of cosmetic procedures that appearance-conscious Americans are resorting to in increasing numbers. The American Society of Plastic and Reconstructive Surgeons provides this guide to today’s most-elected interventions with nature.

Breast enlargement: Augmentation Mammoplasty. Enhances the size and shape of breasts using artificial implants.

Procedure: Lasts 1 to 2 hours. Local anesthesia with sedation, or general. Usually outpatient.

Side effects: Temporary pain. Swelling, soreness, numbness of abdominal skin, bruising, tiredness for several weeks or months.

Recovery: Back to work in 2 to 4 weeks. More strenuous activity after 4 to 6 weeks or more. Fading and flattening of scars: 3 months to 2 years.

Risks: Blood clots. Infection. Bleeding under the skin flap. Poor healing resulting in conspicuous scarring or skin loss. Need for a second operation.

Duration: Permanent.

Breast Lift: Mastopexy. Raises and reshapes sagging breasts by removing excess skin and repositioning remaining tissue and nipples.

Procedure: Lasts 1 1/2 to 3 1/2 hours. Local anesthesia with sedation, or general. Usually outpatient. Sometimes inpatient. 1 to 2 days.

Elvis and Priscilla. Photo by Elena

Side effects: Temporary bruising, swelling, discomfort, numbness, dry breast skin. Permanent scars.

Recovery: Feeling better, back to work in a week.

Risks: Thick, wide scars; skin loss; infection. Unevenly positioned nipples. Permanent loss of feeling in nipples and breast.

Duration: Variable; Gravity, pregnancy, aging, and weight changes may cause new sagging. May last longer when combined with implants.

Chemical Peel: Phenol, trichloracetic acid (TCA). Restore wrinkled, blemished, unevenly pigmented or sun-damaged facial skin, using a chemical solution to peel away skin’s top layers. Works best on fair, thin skin with superficial wrinkles.

Procedure: Takes 1 to 2 hours for full face. No anesthesia – sedation and EKG monitoring may be used. Usually outpatient. Full-face phenol peel may require admission for 1 to 2 days.

Side effects: Both: Temporary throbbing, tingling, swelling redness; acute sensitivity to sun. Phenol: Permanent lightening of treated skin; permanent loss of ability to tan.

Recovery: Phenols: Formation of new skin in 7 to 21 days. Normal activities in 2 to 4 weeks. Full healing and fading of redness in 3 to 6 months: New skin within 5 to 10 days.

Risks: Both: Tiny whiteheads (temporary); infection; scarring; flare-up of skin allergies, fever blisters, cold sores. Phenol: Abnormal color changes (permanent); heart irregularities (rare).

Duration: Phenol is permanent, although new wrinkles may form as skin ages. TCA is variable (temporary).

Collagen/Fat injections: Plump up creased, furrowed, or sunken facial skin; add fullness to lips and backs of hands. Works best on thin, dry, light-colored skin.

Procedure: Lasts 15 minutes to 1 hour per session. Collagen: usually no anesthesia; local may be included with the injection. Fat requires local anesthesia. Outpatient.

Side effects: Temporary stinging, throbbing, or burning sensation. Faint redness, swelling excess fullness.

Risks: Collagen: allergic reactions including rash, hives, swelling, or flu-like symptoms; possible triggering of connective-tissue or autoimmune diseases. Both: contour irregularities; infection.

Duration: Variable, from a few months to as long as a year.

Dermabrasion: Mechanical scraping of the top layers of skin using a high-speed rotary wheel. Softens sharp edges of surface irregularities, including acne and other scars and fine wrinkles, especially around mouth.

Procedure: Lasts a few minutes to 1 1/2 hours. May require more sessions. Anesthesia: Local, numbing spray, or general. Usually outpatient.

Side effects: Temporary tingling, burning, itching, swelling, redness. Lightening of treated skin, acute sensitivity to sun; loss of ability to tan.

Recovery: Back to work in 2 weeks. More strenuous activities in 4 to 6 weeks. Fading of redness in about 3 months. Return of pigmentation/sun exposure in 6 to 12 months.

Risks: Abnormal color changes (permanent). Tiny whiteheads (temporary). Infection. Scarring. Flare-up of skin allergies, fever blisters, cold sores.

Duration: Permanent, but new wrinkles may form as skin ages.

Eyelid Surgery: Blepharoplasty. Corrects drooping upper eyelids and puffy bags below the eyes by removing excess fat, skin, and muscle. (May be covered by insurance if used to improve vision).

Procedure: Lasts 1 to 3 hours. Usually, local anesthesia with sedation, occasionally general. Usually outpatient.

Side effects: Temporary discomfort, tightness of lids, swelling, bruising. Temporary dryness, burning, itching of eyes. Excessive tearing, sensitivity to light for first few weeks.

Risks: Temporary blurred or double vision; blindness (extremely rare). Infection. Swelling at corners of eyelids; tiny whiteheads. Slight asymmetry in healing or scarring. Difficulty in closing eyes completely (rarely permanent). Pulling down of the lower lids may require further surgery).

Recovery: Reading in 2 or 3 days Back to work in 7 to 10 days. Contact lenses in 2 weeks or more. Strenuous activities, alcohol in about 3 weeks. Bruising and swelling gone in several weeks.

Duration: Several years to permanent.

Facelift: Rhytidectomy: Improve sagging facial skin, jowls, and loose neck skin by removing excess, tightening muscles, redraping skin. Most often done on men and women over 40.

Procedure: Lasts several hours. Anesthesia: Local with sedation, or general. Usually outpatient. Some patients may require short inpatient stay.

Side effects: Temporary bruising, swelling, numbness, and tenderness of skin; tight feeling, dry skin. For men, permanent need to shave behind ears, where beard-growing skin is repositioned.

Recovery: Back to work in 10 to 14 days. More strenuous activity in 2 weeks or more. Bruising gone in 2 to 3 weeks. Must limit exposure to sun for several months.

Risks: Injury to the nerves that control facial muscles, loss of feeling (usually temporary but may be permanent). Infection. Poor healing, excessive scarring. Change in hairline.

Duration: Usually about 5 to 10 years.

Facial implants: Change the basic shape and balance of the face using carefully styled implants to build up a receding chin, add prominence to cheekbones, or reshape the jawline. Implants may be natural or artificial.

Procedure: Lasts 30 minutes to 2 hours. Anesthesia: Local with sedation, or general. Usually outpatient.

Occasionally requires overnight stay.

Side effects: Temporary discomfort, swelling, bruising, numbness and/or stiffness. In jaw surgery, inability to open mouth fully for several weeks.

Recovery: Back to work in about a week. Normal appearance in 2 to 4 weeks. Activity that could jar or bump face after 6 weeks or more.

Risks: Shifting or imprecise positioning of implant, or infection around it, requiring a second operation or removal. Excess tightening and hardening of scar tissue around an artificial implant (“capsular contracture”), causing an unnatural shape.

Duration: Permanent.

Forehead lift: Browlift. Minimize forehead creases, drooping eyebrows, hooding over eyes, furrowed forehead, and frown lines by removing excess tissue and redraping skin. Most often done on people over 40.

Procedure: Length: 1 to 2 hours. Anesthesia: Local with sedation, or general. Usually outpatient.

Side effects: Temporary swelling, numbness, headaches, bruising. Possible itching and hair loss for several months. Change of hairline.

Recovery: Back to work in 7 to 10 days. More strenuous activity after several weeks. Bruising gone after 2 to 3 weeks. Limited exposure to sun for everal months.

Risks: Injury to facial nerve, causing loss of motion, muscle weakness, or asymmetrical look. Infection. Broad or excessive scarring.

Duration: Usually about 5 to 10 years.

Hair replacement surgery: Fill in balding areas with the patient’s own hair using a variety of techniques including scalp reduction, tissue expansion, strip grafts, scalp flaps, or clusters of punch grafts (plugs, miniplugs, and microplugs). Works best on men with male pattern baldness after hair loss has stopped.

Procedure: Lasts 1 to 3 hours. Some techniques may require multiple procedures over 18 months or more. Anesthesia: Usually local with sedation. Flaps and tissue expansion may be done with general anesthesia. Usually outpatient.

Side effects: Temporary aching, tight scalp. An unnatural look in early stages.

Recovery: Back to work: usually in 2 to 5 days. More strenuous activities after 10 days to 3 weeks. Final look: may be 18 months or more, depending on procedure.

Risks: Unnatural look. Infection. Excessive scarring. Failure to “take.” Loss of scalp tissue and/or transplanted hair.

Duration: Permanent.

Liposuction: Suction-assisted lipectomy. Improve body shape using tube and vacuum device to remove unwanted fat deposits that don’t respond to dieting and exercise. Locations include chin, cheeks, neck, upper arms, above breasts, abdomen, buttocks, hips, thighs, knees, calves, ankles.

Procedure: Lasts 1 to 2 hours or more, depending on extent of surgery. Anesthesia: Local, epidural, or general. Usually outpatient. Extensive procedures may require short inpatient stay.

Side effects: Temporary bruising, swelling, numbness, burning sensation.

Recovery: Back to work in 3 to 7 days. More strenuous activity after 2 to 3 weeks. Swelling and bruising subsides in 3 to 6 months.

Risks: Infection. Excessive fluid loss leading to shock. Fluid accumulation. Injury to the skin. Rippling or bagginess of skin. Pigmentation changes (may become permanent if exposed to sun). Excessive scarring if tissue was cut away. Need for second procedure to remove additional tissue.

Duration: Permanent.

Nose surgery: Rhinoplasty. Reshape nose by reducing or increasing size, removing hump, changing shape of tip or bridge, narrowing span of nostrils, or changing angle between nose and upper lip. May relieve some breathing problems.

Procedure: Length: 1 to 2 hours or more. Anesthesia: Local with sedation, or general. Usually outpatient.

Side effects: Temporary swelling, bruising around eyes and nose, and headaches. Some bleeding and stuffiness.

Recovery: Back to work or school in 1 to 2 weeks. Avoid hitting nose or sunburn for 8 weeks. Fina appearance after a year or more.

Risks: Infection. Small burst blood vesselss resulting in tiny, permanent red spots. Incomplete improvement, requiring additional surgery.

Duration: Permanent.

Tummy tuck: Abdominoplasty. Flatten abdomen by removing excess fat and skin and tightening muscles of abdominal wall.

Procedure: Lasts 2 to 5 hours. Anesthesia: General or local with sedation. In- or outpatient, depending on individual circumstances.

Side effects: Temporary pain. Swelling, soreness, numbness of abdominal skin, bruising, tiredness for weeks or months.

Recovery: Back to work in 2 to 4 weeks. More strenuous activity after 4 to 6 weeks or more. Fading and flattening of scars in 3 months to 2 years.

Risks: Blood clots. Infection. Bleeding under the skin flap. Poor healing resulting in conspicuous scarring or skin loss. Need for a second operation.

Duration: Permanent.

In aesthetic procedures, eyelid surgery is most popular among women, but men prefer to have their noses altered.