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Modern advancements in plastic surgery
According to ASAPS, the top five surgical procedures for that year were lipoplasty (liposuction), breast augmentation, blepharoplasty (cosmetic eyelid surgery), rhinoplasty (nose reshaping), and abdominoplasty (tummy tuck). The top five non-surgical procedures for 2005 were Botox, laser hair removal, hyaluronic acids, microdermabrasion and chemical peels. Interestingly enough, with the current popularity of cosmetic surgery as it gets a boost from various reality television programs such as ABC's Ultimate Makeover, the results from the ASAPS' 2005 report show that there is only a slight decrease of 4 percent in the total number of cosmetic procedures performed between 2004 and 2005. Considering the current nationwide infatuation with cosmetic surgery, it seems as though not only are physical appearances changing, but attitudes concerning plastic surgery are changing as well.
Dr. Clifford Coleman, board certified plastic surgeon (American Board of Plastic Surgery) with his own private practice in Carbondale, is also affiliated with Memorial Hospital of Carbondale and Herrin Hospital. Having spent 26 of his 29 years of private practice in Carbondale, he said that the demand for plastic surgery is on the increase with people living longer and competing with younger professionals at the workplace. "The market is definitely expanding since people want to look their best. There is something called age discrimination and no one wants to look older than they have to," he said. Positive attitudes about cosmetic surgery may be influencing the popularity of the field, but the availability of new technologies are also a major factor attributing to the overwhelming number of individuals undergoing these types of surgical and non-surgical procedures. "There are several new procedures, materials, technologies and treatments that are constantly being worked on," Coleman said. "For example the hunt is on for the perfect, long lasting, off-the-shelf, cost effective filler that can be put into patients to repair contour defects," he said. According to him, soft tissue fillers have been around for years. You can take fat from somewhere else in the body and use it to fill wrinkles and other depressions. But the body reabsorbs it completely within six months or they may be other problems like asymmetry. "The trouble with collagen, another filler option, is that it is only good in small amounts and has to be re-injected every few months, since it's not long lasting," he said. "But Restylane seems to show some promise." Restylane is a naturally degradable gel that is injected into the skin in order to fill out wrinkles and folds or to sculpt lips, cheeks and the chin. Modern advancements, like the laser, have made many procedures less time consuming, with non-surgical procedures taking anywhere from 5-to-30 minutes. Minimally invasive procedures also give patients a break, dramatically reducing overall healing time. According to Nicole Sommer, assistant professor at the Plastic Surgery Institute at SIU's School of Medicine, lasers have been a defining factor in the progression of the cosmetic surgery field and are a big part of non-surgical plastic surgery. "We use many different lasers to treat various conditions such as age spots, tattoos, wrinkles, skin discoloration, spider veins and hair reduction," Sommer said. "Laser technology is always improving and there are definitely some lasers out there that do a great job of treating most problems, but again, there are other procedures that have not proven to be effective when using lasers." The most promising option in laser technology, although still new, is the Fraxel laser used for facial procedures. Sommer said this laser injures the skin in a way that allows for new collagen formation, which decreases wrinkles, but at the same time has very few side effects and little recovery time. It is basically a tool for facial rejuvenation and wrinkle removal, without the negative side effects of other similar treatments such as the CO2 laser and the Erbium laser, which cause weeks of scabbing and redness. In addition to the Fraxel laser there are other alternatives that have been helping to provide more options for patients interested in plastic surgery. Sommer said minimally invasive surgery like endoscopic surgery for brow lifts, for instance, has now been around for a while and is used by some surgeons who are happy with the results. Leading technologies such as lasers have made a remarkable impact in the plastic surgery field, but more importantly, these new developments are affecting patients even more, especially those undergoing surgery to correct issues non-related to aesthetic appeal. Gerald G. Edds, owner and medical director of Aesthetic Surgery Center in Owensboro, Kentucky, understands how simple reconstructive procedures can change lives. "My practice is almost totally surgical in nature and the percentage of reconstructive procedures I perform is about 5 percent of my total patient base," Edds said. "In order to help give back to my community, I donate my time and medical services to victims of domestic violence through the National Domestic Violence Project. Although I know there are many persons out there who need these types of services, I usually only see a couple of cases per year." Coleman said he would put the number of cosmetic and reconstructive surgeries he performs at 50:50. "In larger cities like St. Louis, you will find plastic surgeons focusing exclusively on cosmetic surgery, since it tends to be more lucrative," he said. Whether for aesthetic value or corrective reasons, cosmetic surgery is an option many are turning to. Similar to the technological advancements the field is experiencing, new trends in financing these procedures have emerged as well. There are many options now for payment plans through the doctors' offices that were not available in the past. Insurance companies, in general, have not been known to pay for procedures they consider cosmetic, with the exception of deformities after massive weight loss or injury. Coleman said that while an insurance company might agree to pay for an abdominal panniculectomy (the surgical removal of excess abdominal panniculus which in layman's term is called the "apron"; the superfluous layer of fat tissue at the lowest portion of the abdominal wall) most insurance companies refuse to pay for the other extended procedures needed to help a gastric bypass patient. "It's another area to wrestle with the insurance companies; a five hour surgical procedure, in the operating room alone can set a patient back by $15,000 to $20,000 and if insurance doesn't pay for that, the cost becomes prohibitive for mainstream America," Coleman said. Augmentation is usually never covered by insurance unless the implant is being used as part of a breast reconstruction after mastectomy. "State law now mandates that insurance companies pay for breast reconstruction after breast cancer treatment and any matching procedure to the opposite breast. It took years of plastic surgeons working on this to finally make it a law," Sommer said. "Unfortunately, this does not apply to congenital deformities of the breast, which is very concerning for me as a breast surgeon. Most women have some asymmetry of their breast and I agree that this is normal, however, young women who have breasts which are drastically different cup sizes, should not be denied improvement of their asymmetry, but unfortunately they are," she added. "It's a never ending battle for looking good," Coleman said. "Women come in asking for drastic procedures for which they might not even be candidates for, just because their husbands are looking at other women." "Or young girls think they need a plastic surgeon to suck the fat out of them, so that they can look like the skinny models they see on TV," Coleman said. In such cases, Coleman said it's a challenge to give them the proper advice and steer them clear of surgery, since plastic surgeons can only fix a surgical problem. "We cannot fix marriages, image issues, and other social, emotional and psychiatric problems the patient may be dealing with," Coleman said. Coleman strongly believes that "The only reason a person should opt for plastic surgery is because they want to feel better about themselves. They shouldn't do it for any other reason." As technology grows, more doors will open up the cosmetic surgery world. According to Sommer, the future of plastic surgery holds an increasing numbers of noninvasive, non-surgical procedures, improved lasers, and the development of new lasers. "In terms of where cosmetic surgery is going in the future, I see both a positive and negative direction," Edds said. "Unlike the past, when new technologies were put through medical trials and written up in official medical journals prior to being available to the public, we now see direct to consumer marketing. "Many times, physicians are made aware of a new, magical technology after patients have seen it on mass media venues. This is a backdoor method of creating demand for new devices, etc," Edds said. According to Edds, Hollywood and television's portrayal of plastic surgery can have a negative impact on the cosmetic surgery industry by depicting approaches or procedures not embraced by mainstream, conservative surgeons. "As for the positive changes in the future, I see a return by many to more conservative approaches," Edds said. "The thrust is likely to be 'a less is more' philosophy, with smaller procedures being performed at an earlier age to ward off the effects of aging. Hopefully, new, safe devices, lasers, etc, will allow us to practice the art of cosmetic surgery in a manner that is beneficial to our patients." Coleman agrees, "Minimal risk with high benefit is what we aim for." Comments
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