ONLY 15 YEARS ago, many people seeking plastic surgery wore veils when they visited a plastic surgeon`s office or had the surgery performed on a Saturday morning and immediately went on vacation.
Since then, cosmetic surgery has come out of the closet and people in record numbers are having facelifts, nose jobs, chemical peels, breast augmentation, tummy tucks, fat suctioning, body contouring and other procedures.
People are no longer hesitant to undergo surgery to change their physical appearance so it is more in tune with their self-image, said Dr. John M. Goin, president of the Chicago-based American Society of Plastic and Reconstructive Surgeons.
A new study done by the society revealed that in 1984 plastic surgeons performed 1.8 million operations. Of these, nearly half a million operations were done for cosmetic reasons, which insurance usually does not cover, representing a 60 percent increase over 1981.
The top five procedures in the growing search for the body beautiful are breast augmentation, eyelid surgery, nose jobs, fat suctioning and facelifts. Seventy-five percent of cosmetic procedures are performed on an outpatient basis, with costs ranging from $800 for a hair transplant to $2,700 for a facelift.
Fat suctioning, or suction assisted lipectomy, only became available in 1982 in this country. In this procedure a thin tube is used to suction out resistant deposits of fat around the thighs, abdomen, buttocks and face. Nearly 56,000 procedures were performed last year.
Reconstructive plastic surgery, usually covered by insurance, climbed even higher. Nearly 1.4 million reconstructive operations were performed last year, an 88 percent jump over 1981.
The most prevalent reconstructive procedures are tumor removal, hand repair, repair of injuries caused by industrial or lawn mower accidents and lacerations.
”Plastic surgery no longer has the stigma that was attached to it back when people thought it was tampering with nature,” said Dr. Peter McKinney, professor of plastic surgery at Northwestern University.
McKinney said 65 percent of the patients in his practice are housewives who want to feel good about themselves, 25 percent are people who want to look better to compete with younger people and 10 percent are in show business.
Not only is plastic surgery improving body images, it is also restoring them and thereby preventing psychological damage.
The number of breast reconstruction operations performed last year reached nearly 100,000, a dramatic 400 percent increase over 1981. Such reconstruction, which the state of California believes is so important it requires health insurance companies to pay for the procedure, restores a near- normal looking breast in patients who have undergone breast cancer surgery.
”The overall increase in operations has been explosive, but I think it reflects a deep concern people have always had,” said Goin of the Los Angeles County/University of Southern California Medical Center.
”Although we have seen for hundreds of years people`s concern for a better body image, in the use of corsets, rouge, wigs and the like, the public just recently has recognized that plastic surgery offers another means to further improve an individual`s self-image,” he said.
But there is a dark side to the plastic surgery boom, Goin said. Attracted by the public`s growing interest, some untrained doctors are doing these procedures, creating a growing menace to unwary patients, he said.
”It behooves prospective patients to be extra careful about the credentials of the doctor they are going to before they agree to have plastic surgery done,” he said. Board certification by the American Board of Plastic Surgery is assurance that a surgeon has been fully trained, he said.
The two major factors behind the surprising growth in plastic surgery are the development of new surgical techniques that have greatly improved outcomes and changing public attitudes that now accept plastic surgery as routine, he said.
Driving these changes are such things as the fitness boom, the youth-oriented society, older workers who want to compete with younger ones and the growing number of people who are unwilling to accept the ravages of aging, he said.
Grandmothers at the turn of the century were expected to sit in rocking chairs and maybe bake cookies for their grandchildren, he said. Today grandmothers can be found sitting in company board rooms, playing tennis, shopping and traveling.
”They want to feel better about themselves,” Goin said. ”They tell me, `I look in a mirror and an elderly person is looking back at me. But I don`t feel old inside. I want the outside to look as young as I feel on the inside.` ”
The first wave of female executives used to worry only about competing with men, Goin said. But now they are competing with young, very aggressive women, and they often feel their appearance could work against them, he said. More businessmen are seeking cosmetic surgery, and some companies are footing the bill because they consider it a bonus to have younger looking top executives, he said.
Studies indicate that people who say they want cosmetic surgery to advance their careers very often accomplish their goals, Goin said.
”The change does not take place just because the individual has a new nose or has a facelift,” he said. ”It is the renewed or improved sense of their self-image that usually follows esthetic surgery that gives them more confidence and can lead to the advancement in their job.”
One out of four nose jobs, one out of seven eyelid surgeries and one out of ten facelifts performed last year were done on men, as were almost all of the hair transplants.
”Basically a man`s motivation for having esthetic surgery is not any different from a woman`s; it is a matter of self-improvement,” said Dr. Bernard L. Kaye of the University of Florida College of Medicine,
Jacksonville.
A patient may want to look better for his own personal satisfaction, or he may have had a recent change in his lifestyle that leads him to seek cosmetic surgery, Kaye said.
”A man who has experience and also feels confident about his appearance has a definite edge over younger, less experienced individuals,” he said.
The way people respond to other people tends to be influenced by their appearance. A receding chin, for example, is often seen as a sign of weakness, and this perception may eventually affect a person`s personality, Kaye said.
But a receding chin can be surgically changed to make it stick out in a more authoritative manner. Last year, 23 percent of the 17,500 chin augmentation operations were performed on men.
Otoplasty, an operation performed to ”pin back” or alter the shape or position of the ear, is even more popular with men. Nearly half of the 13,200 otoplasties done last year were performed on men.
”It is very traumatic for a young adolescent, or an adult for that matter, to live with oversized, floppy ears,” Kaye said. ”Being called names such as `Dumbo` or `Dog Ears` can undoubtedly affect the way a person feels about himself.”
One of the most dramatic changes in plastic surgery is the great upsurge in breast reconstruction, Goin said. A few years ago women were happy to get rid of the cancerous tissue, and they gave little thought to reconstructing the removed breast, he said.
”Now more and more women are realizing a renewed sense of self-esteem and better body image after breast reconstruction, and they are sharing that experience with other women,” he said. Knowing that breast reconstruction is available has gone a long way toward easing the fears of breast cancer diagnosis and surgery, he added.
Actually, it was women demanding reconstruction that turned the tide, said Northwestern`s McKinney. Now it is routine for women to consult with their cancer surgeons and their plastic surgeons to map out a plan for reconstruction, he said. One out of three patients chooses to have breast reconstruction at the same time as the cancer operation.
”The increasing numbers are satisfying because they show we`re getting better at it,” McKinney said. ”We were lousy before. A reconstructed breast does not exactly duplicate a normal breast, but it comes fairly close in most cases.”
The newest breast reconstruction technique uses an expandable plastic pouch implanted under the skin. Salt water is injected into the pouch each week to increase its size and stretch the skin. When the skin is stretched to the desired size, the pouch is removed and replaced with a permanent plastic breast implant.
