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Cosmetic surgery is more than just trying to recapture lost youth, it’s about feeling confident and comfortable with the way you look. And new and improved procedures are making that easier than ever.
Sharon Engbrecht felt pretty good about her body and her life — except when she saw the reflection of her neck in the mirror.
“I had a ‘turkey gobbler’ thing going with my neck, with a lot of wrinkles and loose skin, and I hated it,” says the trim 62 year old. “Turning 60 was much harder for me than turning 40 or 50,
and seeing my neck like that just made me feel old.”
So Engbrecht did some online research, talked to some of her friends and gathered word-of-mouth recommendations. Then she traveled from her Indianapolis home to Naperville, where cosmetic and reconstructive surgeon Dr. Daniel Danahey performed a cervicoplasty — commonly called a neck lift — and made her look several years younger and feel much happier.
“I heard about Dr. Danahey from one of my friends who’d gone to him for a cosmetic procedure, and she looked so good that I thought it was worth the trip to go see him,” she explains. “My neck lift was painless, with no side effects, and it made me feel a lot better about myself and about getting older.”
Twenty years ago, Engbrecht’s friends might have advised her to wait a few more years, save up and then splurge on a complete facelift. But women in the greater Chicago area have adopted a more open but less aggressive approach to cosmetic surgery, area doctors agree.
“There’s definitely more acceptance for cosmetic surgery now than there was 30 years ago,” asserts Dr. Bahram Ghaderi of St. Charles Plastic Surgery. “Back then, people didn’t live as long and they didn’t worry so much about how they looked as they aged because everyone around them was in the same boat. Now, people are not only living longer, they’re leading healthier lifestyles and they’re active longer, so they want to look as young as they feel.”
An ever-expanding range of more localized procedures using noninvasive or minimally invasive techniques is making it easier, cheaper and safer for people to refresh their appearance without undergoing an entire facelift. “Even 20 years ago, people who wanted help looking younger had two options: full surgery or nothing,” notes Dr. Bryan Rubach of the Center for Cosmetic and Laser Surgery in Naperville. “That really limited the number of people who were able and willing to go through cosmetic surgery. Now people can come into the office for a small outpatient procedure every few years and maintain their youthful appearance while putting off a facelift indefinitely.”
A newly revived procedure once used by 1930s movie stars — not to mention Cleopatra, according to legend — offers a spa-like introduction to cosmetic surgery, especially for women who don’t want to change the shape of their facial features. Called dermaplaning, it consists of a doctor using a surgical blade to carefully shave off the top layer of dead skin cells and “peach fuzz” facial hair, revealing the fresh layer of epidermis just underneath, says cosmetic surgeon Dr. Ricardo Izquierdo of Face & Body Plastic Surgery of Oak Brook and Naperville.
“Dermaplaning has enjoyed a resurgence because it’s a noninvasive and relatively inexpensive way to improve appearance without making any dramatic, permanent changes to the face,” explains Izquierdo. “It really revitalizes the skin and gives a natural glow to the tissues.” Adding a superficial chemical peel to the process enhances the effect, he adds.
A new generation of facial fillers also can make those trips to the cosmetic surgeon’s office less frequent, says Danahey. “Collagen injections get resorbed by the body in three to four months,” he explains. “Newer fillers, like Radiesse, can last as long as a year. Now we have new hyaluronic acid-based fillers like Voluma, which can last up to two years and is safer because hyaluronic acid already exists in the skin, so people aren’t generally allergic to it.”
In fact, the hyaluronic acid in Voluma and other new fillers can slow down the skin’s normal aging process, notes Dr. Jennifer Hein of Women’s Institute of Cosmetic and Laser Surgery in Geneva and Naperville. “As people age, the amount of hyaluronic acid in their skin decreases and the skin starts to break down, causing sags and wrinkles,” she says. “The acid in the fillers refreshes the skin from the inside.”
Fillers also are becoming more specialized, which lets doctors apply them to parts of the face that once could be treated only with surgery. “Now we can use fillers to flesh out the cheeks and temples, especially for runners who tend to lose more underlying fat in those areas,” Danahey says. “Now they can enjoy the health benefits of running without getting that ‘gaunt’ look that turns some people off exercise.”
Voluma increases doctors’ ability to change facial contours nonsurgically because it comes in different thicknesses, Izquierdo states. “Voluma is designed to be placed deeper under the skin than most fillers, and you can manipulate it almost like Play-Doh,” he says. “You can place a line of it up against the bone of the mandible and maxilla and make subtle changes that leave the patient still looking like himself or herself, but younger and fresher.”
The best part about the latest fillers is that their effects are easily reversible. “The hyaluronic fillers contain fibers bound together by sugar molecules,” Rubach explains. “If the patient doesn’t like the results of a procedure, the doctor can inject a chemical that breaks the sugar bonds and lets the body resorb the fibers.”
Patients who are willing to spend a day in the doctor’s office and up to a week recovering at home can replace the lost subcutaneous fat that left their faces wrinkled with fat cells harvested from their own abdomens and injected into their cheeks. “Fat grafting is permanent: the body grows new blood vessels to serve the transplanted fat cells, so they stay in place forever,” Danahey observes. “The process is more time-consuming and expensive, but it never has to be repeated.”
The doctor extracts fat from the patient’s upper abdomen near the navel with a syringe, then spends two to three hours centrifuging the harvested tissue to remove blood and connective tissue. Then he loads the fat cells into syringes and injects them into the appropriate locations on the patient’s face. The patient is sedated for the facial injections, and the initial swelling takes four or five days to subside, Danahey cautions.
When Botox and fillers aren’t enough to erase the ravages of time, patients can still improve their looks without booking a hospital stay. Many procedures, such as eyelid lifts, brow lifts and neck lifts, can be done in the surgeon’s office with local anesthesia.
“Many patients prefer having smaller procedures performed in the office because it’s less expensive than going to a hospital and it offers more privacy,” says Danahey. “They also usually take less recovery time and produce a less startling, more natural change in appearance than a full face lift does.”
“The best part of having an office procedure for me was that I could have it done with just local anesthesia,” Engbrecht asserts. “I don’t have any problems with being put under, but being awake for my neck lift made me feel better because I could talk with Dr. Danahey and be assured that everything was going well.”
Some of the most common facial surgeries in the U.S. are nose reshaping (rhinoplasty), with about 221,000 procedures performed in 2013; eyelid lifts (blepharoplasty), with 216,000 performed in 2013; and face lifts, with 113,000 performed in 2013, according to the American Society of Plastic Surgeons (ASPS).
Breast augmentation wins hands-down for the most popular cosmetic procedure, beating out everything but Botox and filler injections and chemical peels, the ASPS reports. More than 290,000 women underwent the procedure in 2013 — 37 percent more than those who had it done in 2000.
“Breast implants have definitely become more patient-friendly,” says Dr. Ronald Stefani of Lombard. “The types of silicone used are better because they’re less prone to create problems if they leak. Also, patients can choose from a variety of shapes and sizes that conform more to women’s natural breast anatomy, so they don’t obviously look like they’ve had implants put in.”
Options include smooth implants, which best mimic the feel of natural breasts; cohesive gel “gummi bear” implants, which are firmer and maintain their shape better than traditional silicone implants; and textured implants, which bond more tightly to the surrounding tissue to reduce the risk of shifting within the breast.
“Cohesive gel implants are a fantastic innovation,” Hein asserts. “They’ve been the number one choice in Europe and South America for years. They’re safer because the gel doesn’t leak out if they get damaged, and they have a variety of shapes that can match the patient’s original breast contours, so they look much more natural than traditional silicone implants. They also don’t develop folds or rippling like some other types of implants.”
Women who want to rejuvenate aging, sagging breasts should avoid implants unless their own breasts are naturally small. Ghaderi warns. “If a woman has a normal breast volume, but her breasts are sagging or have loose skin, an implant will only make that situation worse,” he asserts. Instead, he advises that they seek a mastopexy, or breast lift, that will remove the loose skin at the top of the chest and pull the breasts up to their original level. If a patient has A-cup-sized breasts naturally, a surgeon can combine a breast lift with an implant augmentation to improve both the size and the configuration of the breasts, he adds.
Healthy, fit people who are still struggling to lose stubborn pockets of fat on their neck, thighs or belly might not have to go under the knife at all. “Ultrashaping is at the top of my list of brand new technologies in cosmetic surgery,” says Rubach. “It’s noninvasive, nonsurgical body sculpting that really works.”
Using ultrasound waves to destroy fat cells, ultrashaping is one of two noninvasive forms of liposuction. The other is called cool sculpting, which freezes unwanted fat cells through the skin. In both cases, the cells explode and the body resorbs them, leaving the affected area smooth.
Which type of procedure doctors use depends largely on the location of the fat deposit. “The two systems complement each other,” Rubach comments. “Cool sculpting works better on areas that are directly over a bone, such as the outside of the thigh. Ultrashaping works better on fat deposits that lie over soft tissues, like the abs and the flanks.” Ultrashaping is also completely painless and does not affect the skin, while cool sculpting does damage the skin, which takes three or four weeks to heal, he adds.
Some fat deposits can’t be removed safely with the new technologies, warns Stefani. “This is not going to help someone who’s overweight remove an entire layer of fat. It’s only suitable for small fat deposits on otherwise fit people,” he says. “Also, when you impart ultrasound energy to some areas, like under the chin, you can traumatize the surrounding tissues, so it’s not suitable for those areas.”
Once people have lost a significant amount of weight, they may need a surgeon’s help to make the most of their hard-earned slenderness. “The majority of the time, especially with people who’ve had gastric bypass, the skin won’t recover from having been stretched and we have to cut that skin out,” Izquierdo observes. While most skin removal surgeries focus on excess abdominal skin, more patients also are looking for arm lifts to remove hanging skin or “bat wings” from their upper arms.
“An arm lift doesn’t leave the prettiest of scars because it requires a long incision straight down the arm,” says Izquierdo, “but most patients are just happy to get rid of the extra skin.”
WHAT DOES IT COST?
Anyone who’s shopped for high-end cosmetics or designer fashions knows that beauty doesn’t come cheap. But what’s the right price for that smooth forehead, those aristocratic cheekbones or that alluring decolletage?
As a starting point, here are the average costs for some common cosmetic procedures according to 2013 statistics from the American Society of Plastic Surgeons.
• Arm lift: $3,729
• Botox or Dysport Injection: $380
• Breast Augmentation: $3,678
• Breast Lift: $4,207
• Brow Lift: $3,095
• Buttock Lift: $4,515
• Eyelid Surgery: $2,818
• Facelift: $6,556
• Liposuction: $2,866
• Neck Lift: $4,102
• Rhinoplasty/Nose Reshaping: $4,545
• Tummy tuck: $5,217
These prices, however, do not take into consideration a wide range of variables including the experience and expertise of the doctor, the specific circumstances of the procedure being done, and what other service providers might be needed.
Before deciding on a procedure, it’s also important to get details on how much will be charged for materials such as fillers or implants; whether the procedure must be done in a hospital;
if so, with which hospitals the prospective surgeon is affiliated and what their operating room rates are; and what an anesthetist might charge if the procedure requires general anesthesia. And don’t forget to factor in the cost of any follow-up treatments and possible lost work time during recovery.
BEYOND AESTHETICS
New procedures help accident victims, cancer patients and those with congenital deformities
Not every advance in cosmetic surgery benefits patients who just want to look younger or thinner. Accident victims, cancer patients and people seeking to correct congenital deformities also have a few new things to cheer about, area surgeons say.
“Technology continues to improve facial reconstruction,” says Lombard cosmetic surgeon Dr. Ronald Stefani. “We’re seeing new materials and
new procedures.”
Recent improvements to the titanium plates used to repair shattered facial bones enable surgeons to better restore their patients’ pre-accident appearance, says Dr. Daniel Danahey of DuPage Medical Group. “The plates are thinner and lower profile while still being as strong as they were before,” he states. “People forget they even have them. They look and feel so natural.”
A new titanium mesh fabric can help restore facial symmetry after a hard impact to the eye pushes the eyeball down into the upper jaw. “It’s a surprisingly common sports injury,” says Danahey.
“The floor of the eye socket is eggshell thin: it’s actually evolved that way as a protective measure to let the eyeball break through into the maxillary sinus [empty space in the upper jaw] to escape being crushed by a hard blow,” explains Danahey. “If the eye doesn’t completely retract back into the socket, we can replace the broken bone with the mesh to hold the eye at the proper level so it matches the other eye.”
More and more dermatologists as well as reconstructive surgeons are mastering the Mohs procedure for excising skin cancers, thanks to new tissue stains that make it easier for doctors to identify cancerous cells in newly excised skin layers. The procedure, invented in the 1930s by Dr. Frederic Mohs, uses either a scalpel or chemicals to remove a skin cancer one epidermal layer at a time. After each layer is removed, a doctor examines it under a microscope to spot cancerous cells. The process continues until the most recent layer removed contains no cancer cells, Stefani explains.
“Mohs has become much more mainstream because it preserves more healthy skin tissue than other surgical removals,” adds Stefani. “It also requires little down time: the surgeon can usually reconstruct the affected tissue the next day.”
And a new device under development could reduce the number of suspicious moles that are needlessly cut out of peoples’ skin, saving them pain, fear and expense.
“Dermascopes will work on skin like X-ray machines work on bone,” Stefani asserts. “Doctors will be able to use them to determine if a mole is cancerous without having to remove it. It won’t happen in the next few years, but when dermascopes are perfected, it will be wonderful for patients to not have to go through the removal process every time they have a suspicious mole.”
