Statistics show that pre-wedding cosmetic procedures and plastic surgeries are on the rise, thanks to the growing use of social media and photo-sharing sites that is forcing many people to look good online. But there is one question that needs to be answered: Is it a good idea?
Leading Inland Empire plastic surgery expert Dr. Tarick Smaili says there is no “strict” answer since several variables should be taken into account beforehand, such as the patient’s motives and expectations, emotional and psychological health, medical condition, and even her wedding day.
A 2012 survey conducted by the American Academy of Facial Plastic and Reconstructive Surgery has shown that the most popular pre-wedding cosmetic procedures were medical-grade chemical peels, dermal fillers, and Botox injections.
Dr. Smaili says it is not surprising that most brides- and grooms-to-be choose non-surgical treatments because these have no or very little downtime, although it remains ideal to have them at least two to three weeks before the “D-day” to make sure the residual swelling, redness, and bruising have enough time to subside.
The popularity of these non-surgical facial rejuvenation procedures, particularly Botox injections and dermal fillers, as a pre-wedding “gift” just reflects a recent survey showing that Americans are getting married later, thus early signs of aging such as fine wrinkles and loss of facial volume or fat—which might show in wedding photos—are common concerns of brides and grooms.
Chemical peels are also popular among brides-to-be as they can erase or at least minimize skin imperfections such as freckles and sunspots.
But some brides and grooms do not shy away from “real” plastic surgery. According to a recent survey, rhinoplasty, or more commonly referred to as nose job, eyelid surgery, breast augmentation, and facelift are the most commonly requested pre-wedding surgical enhancements.
Dr. Smaili warns that any surgical procedure should be performed at least three to six months ahead lest the subsequent postop symptoms such as swelling and bruising could attract unwanted attention during the “event.” This is particularly true for facial plastic surgeries such as rhinoplasty and facelift.
But even body contouring such as tummy tuck and breast augmentation requires a minimum of four months of recovery, Dr. Smaili warns.
Rushing one’s recovery could also result in elevated blood pressure and heart rate, which Dr. Smaili says is linked to poor wound healing, higher risk of hematoma or pooling of clotted blood within the tissue, and other complications that could prevent the patient to achieve optimal results from her surgery.
More than one-third of US adults are obese, which is defined as excessively high body fat percentage. To determine overweight and obesity ranges, doctors use the patient’s weight and height to calculate his body mass index (BMI), with 30 and higher considered obese.
And with the looming obesity problem in the US, the number of patients seeking weight loss surgeries, also referred to as bariatric procedures, is increasing as well. But this also leads to a subsequent trend—more people asking for body lift such as tummy tuck, arm lift, breast lift, thigh lift, and lower body lift.
According to data released by the American Society of Plastic Surgeons website, last year body lift after weight loss grew at its fastest rate since 2009, when this organization began tracking procedures specifically performed on massive weight loss patients.
Tummy tuck surgery, which removes the apron-like skin in the midsection using a hip-to-hip incision, remained the most commonly performed body lift after weight loss, with around 17,260 patients receiving the procedure, a 4 percent increase from the previous year.
While the redundant skin affects several body regions, most MWL patients work first on their midsection where the hanging extra tissue is particularly problematic as it leads to poor hygiene, skin ulcers, non-healing irritation, foul odor, and functional problems.
Functional problems are not uncommon following dramatic weight loss because the ensuing redundant skin (especially in the midsection and inner thigh) makes it uncomfortable or difficult to perform daily activities and exercise.
The second most popular procedure performed on MWL patients during the same period was breast lift in which the saggy breast tissue and skin is lifted and reshaped to achieve a perkier appearance. Oftentimes it is combined with reduction mammoplasty or “downsizing” of breast to prevent drooping recurrence and/or to achieve a more balanced figure.
More than 12,050 breast lift surgeries were performed in 2014, according to the survey.
But thigh lift and arm lift surgeries had their highest single-year growth during a five-year period, both up 9 percent.
Dr. Tarick Smaili, a Los Angeles plastic surgeon, says the most commonly mentioned benefits of body lift after weight loss are usually cosmetic-related, although it has been well documented that improvement in quality of life and body image is also possible after body contouring performed on MWL patients.
According to a 2013 study, tummy tuck may lead to long-term weight loss for MWL patients possibly due to increased satiety as the procedure typically involves removal of some abdominal fat, which is believed to control appetite.
Male bodybuilders with abnormal breast enlargement might benefit from a body contouring procedure called gynecomastia surgery but only after medical conditions such as hormonal problem have been ruled out.
According to a study published by Plastic and Reconstructive Surgery medical journal, gynecomastia surgery performed on bodybuilders results in high patient satisfaction, although in general they require a different surgical approach from “ordinary” patients.
The study involved more than 1,000 male bodybuilders whose age ranged from 18 to 51, with about 15 percent of them have joined professional bodybuilding competitions.
Prior to surgery, all patients were free of diseases such as tumors and kidney failure that might cause male breast enlargement. Meanwhile, some took steroids or supplements containing hormones during their younger years that resulted in gynecomastia (which more often than not a temporary condition) that become a permanent problem.
The author of the study has concluded that high patient satisfaction among bodybuilders would require a different approach and special attention to prevent bleeding, which is an issue because a well-developed chest muscle is highly vascularized.
Another consideration is that bodybuilders, compared to ordinary patients, have higher expectations and goals from their surgery.
The study, which claimed that most respondents were extremely satisfied with the results, also looked into the most ideal techniques to prevent increased bleeding, poor cosmetic outcome, and recurrence of gynecomastia.
Aside from using a 1-inch incision to reduce the risk of increased bleeding and poor scarring, the plastic surgeon who conducted the study said that removing all the glandular breast tissue could prevent gynecomastia from recurring.
Another factor contributing to the success of gynecomastia surgery, according to study, is the “right” preparation to minimize increased bleeding and poor scarring. For instance, blood-thinners, supplements known to affect healing (e.g., fish oil, vitamin E, green tea, ginseng, and gingko biloba), and steroids must be avoided months before the procedure.
Meanwhile, the study has shown that complications after gynecomastia surgery were either uncommon or just minor. About 6 percent of the patients experienced hematoma or accumulation of blood within the surgical site.
However, most of the complications reported by patients are less likely to occur with the right preoperative and postoperative care such as avoiding steroids and other supplements/medications known to affect healing, stopping all rigorous activities while the body has not yet fully recovered from the surgical trauma, and performing only light exercise such as walking during recovery.
Breast reconstruction performed on post-cancer patients who had mastectomy may provide higher satisfaction if it involves the use of their own tissue rather than breast implants, according to a recent study published in the January issue of Plastic and Reconstructive Surgery journal.
Using a questionnaire called “Breast-Q” to determine patient satisfaction in terms of cosmetic results and quality of life after breast reconstruction, the researchers assess the “point of view” of 92 women who had the procedure between 2006 and 2010, with 47 chose tissue-based method, while 45 underwent reconstruction via breast implants.
The study has suggested that women who chose tissue-based reconstruction reported higher satisfaction in terms of cosmetic results. Using a 100-point scale, they scored 75 compared to 65.5 for patients who had implant-based reconstructive surgery.
The patients who had reconstruction with the use of their own tissue have also reported higher “overall patient satisfaction,” scoring 82 versus 74.5 in women who had breast implants. However, the two groups scored the same in “various aspects of quality of life” such as sexual, physical wellbeing, and psychosocial.
Meanwhile, the researchers have taken into consideration the differences (demographics) between the two groups of patients. For instance, women choosing tissue-based reconstruction were older: an average of 51 versus 44. They also had a higher body weight, were less educated, and were likely to receive radiation therapy.
The researchers have also noted that since younger patients were more likely to choose breast implants, their lower satisfaction rate in cosmetic results might be due to their higher expectations from reconstructive surgery. Most of the women who belonged to the “implant-based” group also had double mastectomy as a preventive measure due to their pronounced risk to breast cancer (e.g., strong family history).
But despite the difference in patient satisfaction score, both groups have the same complication rates, although the tissue-based reconstruction group had a higher rate of revision surgeries.
Studies and surveys have been conducted in the past, many of them reporting conflicting results in terms of patient satisfaction and quality of life after breast reconstruction through different techniques. This prompted the researchers to conclude that the surgery must be highly individualized to meet most of the patient’s expectations and goals.
There is no significant difference in the complication rate between “older” plastic surgery patients and their younger counterparts, prompting a team of researchers to conclude that surgical enhancement is generally safe as long as performed by board certified plastic surgeons.
According to a recent study presented at the annual meeting of the American Society of Plastic Surgeons (ASPS), patients aged 65 years and older can “safely undergo cosmetic plastic surgery without having to worry about the possibility of higher complication rate than younger individuals” when their procedure is performed by a qualified doctor.
The researchers reviewed the complication rate among the elderly who had surgical enhancements between 2008 and 2013 and found that it was 1.94 percent, which they interpreted as “statistically insignificant” compared to 1.84 percent among younger patients.
Even among octogenarian patients—i.e., 80 years and older—the 2.2 percent complication rate was considered statistically insignificant compared to those experienced by younger individuals.
The median age of senior patients was 69.1 at the time of their surgery, and for younger individuals it was 39.2.
The similar rate of complication between older and younger patients occurred even if there was a higher incidence of diabetes among the seniors, 5.7 percent versus 1.6 percent. At the time of their surgery, seniors also had a slightly higher body mass index than their younger counterparts, 25.4 percent compared to 24.2 percent.
According to data, the most common post-op complications in senior patients were infection, hematoma or accumulation of excess blood underneath the skin, and healing problem.
However, the researchers have noted that senior patients were less likely to be a smoker than younger patients, 8.5 percent compared to 3.4 percent.
Because smoking can increase the risk of skin necrosis, infection, and healing problem, most plastic surgeons agree that smokers have to avoid any tobacco product for at least three weeks before and after surgery.
Patients aged 55 years and older accounted for about 24 percent of all cosmetic procedures performed in the US last year, according to data released by ASPS. This trend is expected to even grow due to more seniors postponing retirement and the looming job insecurity.
Meanwhile, Los Angeles plastic surgeon Dr. Tarick Smaili, who is not part of the study, says the patients’ chronological age does not determine their “qualification” for a certain cosmetic surgery, adding that physical health, current weight, and personal goals are the most important considerations.
The US still topped the international chart as the country with the highest number of people undergoing cosmetic plastic surgery in 2013, according to data released by the International Society of Aesthetic Plastic Surgery (ISAPS).
Worldwide, about 23 million cosmetic surgeries and non-surgical enhancements were performed last year, with the US accounted for around 17 percent of the total procedures, the data revealed.
Brazil came second, with more than 2 million procedures, followed by Mexico, with around 884,000 surgical and non-surgical enhancements.
Worldwide, breast augmentation, facelift and eyelid surgery were the most popular procedures among women, while more men preferred rhinoplasty (or nose job), breast reduction and eyelid surgery.
Botox injection, meanwhile, was the most commonly performed non-surgical enhancement worldwide. The treatment uses a small dose of toxin that relaxes the muscles in an attempt to remove or minimize the appearance of wrinkles.
Women remained the biggest consumers in the cosmetic surgery market worldwide, accounting for about 90 percent of all procedures or 20 million treatments. Nevertheless, men are slowly catching up, a trend some experts have attributed to the growing job insecurity and more seniors deciding to work past their retirement age.
In the US, breast augmentation was the most popular surgical enhancement, with board-certified plastic surgeons performing about 290,000 procedures. While the “number” has remained stable over the past several years, at this rate experts have concluded that about 3 percent of American women currently have breast implants.
Among men, nose job was the most popular cosmetic plastic surgery last year, with more than 57,000 patients undergoing the procedure. It was followed by eyelid surgery, liposuction, breast reduction, and facelift.
With the growing acceptance of plastic surgery and the booming beauty industry, some countries have started to tap the lucrative market of surgical enhancement, with some offering cheap procedures that are just a fraction of the cost in US.
However, not all countries dubbed as medical tourism hub have tight government regulations that protect consumers from unskilled doctors and “underground” plastic surgery.