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Press Release February 27 2004

Excessive" Cosmetic Plastic Surgery: How Much is Too Much?

New York, NY (February 27, 2004) -

The American Society for Aesthetic Plastic Surgery (ASAPS) believes it is important to make a clear distinction between such individuals and the millions of normal men and women who elect plastic surgery as a means to enhance their overall sense of well being.

Appropriateness of Multiple Procedures

How much cosmetic surgery is too much? The answer depends on the reasons it is chosen, when it is chosen, and the patient's expectations. A patient who has a strong personal desire for self-improvement and is able to identify specific, realistic goals for surgery is likely to be a suitable candidate for one or more procedures.

Multiple procedures performed at the same time may be appropriate, with proper safety considerations, in order to create or maintain harmony among physical features. For example, a facelift is often combined with eyelid surgery and a brow lift to achieve harmony among the various "aesthetic units" of the face. Following surgery, all parts of the face may then continue the aging process at a more similar rate.

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Over an individual's lifetime, there may be various stages at which cosmetic surgical or nonsurgical enhancements can improve the quality of life. Procedures may be spaced at intervals of a few years, a decade or more - depending on the individual's goals. The following might be a typical sequence of procedures:

>30s: Botox injections to address fine wrinkling around the eyes
Tummy-tuck and breast lift after childbirth and breast-feeding are completed
>40s: Lipoplasty (liposuction) for double chin and fat deposits in hips and thighs
Vein injections to eliminate spider veins
>50s: Facelift, eyelid surgery

Patient Evaluation for Surgery

One clue as to whether a patient is seeking "excessive" surgery is the source and degree of motivation. An individual seeking cosmetic surgery should always be self-motivated; having surgery to please family members, a significant other or spouse is never appropriate. In addition, strongly motivated patients have been found to experience less pain, recuperate faster, and have a significantly higher index of satisfaction.

Individuals with low self-esteem who obsessively focus on minor flaws or believe that surgery will work a miracle in their lives are bound to be disappointed and dissatisfied. Such persons are not appropriate candidates for cosmetic surgery. In extreme cases, individuals exhibiting these traits may suffer from Body Dysmorphic Disorder (BBD), a rare psychiatric condition characterized by an uncontrollable preoccupation with an imagined or slight defect in appearance. Responsible surgeons try to identify inappropriate patients during their preoperative evaluations, and do not recommend surgery for such individuals.

Informed Consent

Patient safety is paramount, and the risks of surgery must always be carefully weighed against the potential benefits. That is why informed consent is so important. Informed consent is the patient's informed decision to proceed with a medical treatment or surgical procedure. In order to give informed consent, a patient must be provided with the facts and information necessary to make an educated choice.

Fully informed consent is in the best interests of both patients and physicians. Plastic surgeons use the consultation process to educate patients about the proposed surgery. Every surgery has inherent risks and benefits; the hallmark of informed consent is the understanding of risks and benefits, and realistic expectations as to outcome. The surgeon must consider the patient's safety over the patient's desires.

During the consultation, the plastic surgeon considers such factors as whether: the patient has difficulty describing the desired change; the patient is unreasonably bothered by what, objectively speaking, is a minor imperfection; the patient's friends and family are supportive or opposed to the procedure; the patient appears depressed or excessively anxious; and the patient has a history of dissatisfaction with cosmetic surgery. If the patient is seeking to repeat a procedure that has been performed in the past, the surgeon must evaluate whether sufficient improvement can be achieved to warrant another operation.

Patients seeking cosmetic plastic surgery may have expectations that are not consistent with what is possible. It is in both the patient's and surgeon's best interests to bring the patient's perspectives in line with the surgeon's before any commitment to surgery. The alternative is regret instead of satisfaction after surgery.

As the leading organization of plastic surgeons certified by the American Board of Plastic Surgery (ABPS) who specialize in cosmetic plastic surgery of the face and body, ASAPS strongly believes that it is in the best interests of prospective patients that inappropriate candidates for surgery are eliminated through the consultation process. It is also in the surgeon's self-interest. However, surgeons are not psychiatrists, and even the most thorough consultation cannot always identify the surgical candidate who is unsuitable for psychological reasons. Inappropriate behavior may not be manifested during the interview process; in fact, it is sometimes carefully masked.

Shared Responsibility

It is ASAPS' position that patients seeking cosmetic surgery have the responsibility to research prospective physicians and make sure they are properly credentialed, certified by the ABPS, with hospital privileges for the procedure being considered (even if the procedure will be performed in an office-based surgical facility). In addition, patients scheduling office-based cosmetic surgery should confirm that the facility is accredited by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) or equivalent agency, state licensed or Medicare-certified. Shared responsibility between patient and surgeon helps to ensure realistic expectations and satisfying surgical results.

COSMETIC SURGERY TIMELINE

Individuals age uniquely and at different rates depending on heredity, lifestyle, sun exposure and other factors. The American Society for Aesthetic Plastic Surgery (ASAPS) provides the following chart as a "typical" timeline for the enhancement and rejuvenation of appearance through cosmetic surgical and nonsurgical procedures:


IDENTIFIED DISSATISFACTION 

COSMETIC PROCEDURE

~

 

MID 20s to MID 30s

 

Early frown lines between brows 

Botox injections

Small or asymmetrical breasts 

Implants

Localized fat deposits 

Lipoplasty

~

 

MID 30s to MID 40s

 

Gradual hooding of upper eyelids 

Upper eyelid surgery or brow lift

Puffiness under eyes

Lower eyelid surgery

Fine wrinkling around eyes

Skin resurfacing and/or Botox

Frown lines between brows 

Botox or endoscopic forehead surgery

Fine wrinkling around lips

Skin resurfacing/chemical peel

Nasolabial folds or creases

Soft Tissue Filler

Fat deposits in hips, thighs, abdomen

Lipoplasty

Muscle weakness/loose abdominal skin

Mini or full tummy tuck

Loss of volume/tone in breasts 

Breast lift with or without implants

Spider veins 

Sclerotherapy (vein injections)

~

 

MID 40s to MID 50s

 

Sagging eyebrows 

Brow lift

Double chin

Lipoplasty

Vertical cordlike structures in neck 

Neck lift/tightening procedure

Descent of cheek fat

Mid-facelift

Development of jowls 

Lower-facelift 

Slight drooping of nasal tip 

Rhinoplasty

Thinning of lips

Lip augmentation

Pattern baldness

Hair restoration

~

 

60s and BEYOND 

 

Facial wrinkles and creases

Skin resurfacing/chemical peel/Botox/Soft Tissue Filler/Fat injections

Recurring facial laxity

Repeat facelift

Excess fat and skin in upper arm 

Upper arm lift


This document was updated from January 15, 2001.

The 2100-member American Society for Aesthetic Plastic Surgery (ASAPS) is the only plastic surgery organization devoted entirely to the advancement of cosmetic surgery. ASAPS is recognized throughout the world as the authoritative source for cosmetic surgery education. U.S. and Canadian members are certified by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada.
Toll-free referral line: 888.ASAPS.11 (272.7711). Web site: www.surgery.org

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