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SAN ANTONIO -- Once it was the exclusive option of the rich and famous, a fortunate few, who sought youthfulness and beauty under pseudonyms in discreet surgical suites and spas, places where bruises and swelling healed unseen and patients emerged refreshed and transformed, rarely revealing they had "work" done.
Now it's all out there for everyone to see. Cosmetic plastic surgery is mainstream middle class, as accessible as a credit card or checkbook, as familiar as a salon facial.
Hide bruises? No need. Talk about it? No problem.
From liposuction to breast augmentations to face-lifts, fat-purging, age-defying, beautifying surgery is booming. Last year, reports the 6,000-member American Society of Plastic Surgeons, some 1.8 million of those surgical procedures were performed, up 4 percent from 2004.
About 291,000 were breast augmentations, up by 10 percent. And while liposuction figures remained unchanged from 2004, it led the list of top procedures among men and women with 324,000 performed.
Surgeons say one of the biggest trends is body contouring and full body lift for the massive weight loss that follows bariatric surgery. According to the American Society for Bariatric Surgery, there were 170,000 bariatric procedures in 2005.
About half those patients will seek plastic surgery to address sagging skin and fat. Considered cosmetic surgery, it is rarely covered by insurance.
With the high obesity rate in the country, "We see no end in sight for those procedures," says Brian Kinney, a Los Angeles plastic surgeon who serves on the plastic-surgeon society's emerging trends committee.
More ethnic patients -- Hispanics, African Americans and Asians -- are seeking cosmetic work, and couples as well as parents and offspring are making it a family affair. Men make up 16 percent of cosmetic-surgery patients, and they recorded a 156 percent rise in tummy tucks, a 729 percent jump in buttock lifts and a 458 percent spurt in lip augmentation since 2000.
Generally, cosmetic-surgery trends can be summed up as sooner, smaller, more natural.
Injectable fillers are growing in popularity -- laser procedures and other minimally invasive techniques to combat wrinkles and lines and put off a face-lift. Surgeons call them "starter treatments" in a continuum from needle to knife, laser to liposuction.
On the surgical side, women and men are going in for smaller surgical procedures at a younger age -- a correction or tightening here and there -- instead of waiting until they're 60 for a major overhaul.
"The biggest change in lipo has been the refinement of suctioning circumferentially," says Rod Rohrich, chairman of the department of plastic surgery at UT Southwestern Medical School and past president of the American Society of Plastic Surgeons.
"You suction all the way around an area, like the inner thighs and the outer thighs." It's liposuction as body sculpting.
As for face-lifts, with people coming in at a younger age, the resulting change is subtle. Then, too, finer surgical techniques help create a more natural look. Rohrich says the tight, windswept look is out. "Plastic surgery is no longer the witness protection program. The sign of good cosmetic surgery is when you can't tell you had a face-lift. You look refreshed and more youthful." Like you, only better.
One procedure that showed up in the statistics for the first time last year was the thread lift, in which barbed sutures are placed under the skin and then drawn up to lift the brow, cheeks and neck.
The appeal is that it can be performed under local anesthetic in a doctor's office. Leroy Young, a St. Louis plastic surgeon who also serves on the emerging trends committee, says the thread lift is good for minimal facial corrections. But it's unclear how long it lasts, though some claim two years. "We found it lasted more like three to six months, which seems like a short time for something that costs as much as $5,000."
Young says lip augmentation is another surgical procedure that patients request, and often it's the popularity of a plump-lipped film star such as Angelina Jolie driving them. But lip procedures actually dropped by 3 percent from 2004 to 2005, signaling that the trend may have cooled.
Sometimes what's labeled hot is not. Surgeons say fad procedures, including vaginal rejuvenation or pectoral implants and calf augmentation, represent more hype than real trends. Consider that in 2005, there were only 793 vaginal rejuvenation procedures, nationwide, as compared to the more than 298,000 nose-shaping operations.
As Kinney points out, the overarching trend is that the line between beauty/fashion and plastic surgery cosmetic procedures has blurred.
Magazines such as Allure seamlessly run splashy spreads on plastic surgery next to features on fashion and makeup. Jeffrey Kenkel, associate professor and vice chairman of the plastic surgery department at the University of Texas Southwestern Medical Center in Dallas, says manufacturers create buzz about their hot new cosmetic devices and products by getting them mentioned in these magazines, sometimes even before doctors know about them.
Patients come in clutching articles.
Along with marketing for cosmetic procedures in the media, plastic surgery is all over television. Programs such as "Nip/Tuck" and "Plastic Surgery: Before & After" create demand for procedures that may or may not be appropriate for patients.
While some TV shows trivialize and glamorize it, others recount scary stories of cosmetic surgery gone bad, tales of botched face-lifts and dire complications from liposuction.
Cosmetic surgery can do marvelous things, improving problem areas, turning back signs of aging and boosting confidence. But surgeons advise that patients do their homework and know that making an incision in an operating room is not like cutting hair in a salon. It is real surgery with real risks.
As Rohrich puts it, "You only have one face and one nose. It's not like getting a bad haircut."
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(E-mail: mpisano@express-news.net)
c.2006 San Antonio Express-News
