Basil Pakeman, M.D., F.R.C.S.
Arnold S. Breitbart, M.D., F.A.C.S.
Dr. Joel Beck
Babak Dadvand, M.D.
What Is Plastic Surgery?
By definition refers to a specialized medical practice that is used for the corrective purposes to physically restore form and function to features of the anatomy.
The term (used as an adjective or noun) is derived from the Greek translation plastikē or plastic denoting the need to surgically sculpt or use the "art of modeling" to re-shape or mold pliable flesh to modify features of the body. Modern aesthetic technologies, techniques, innovations, prosthetics and practices and have allowed plastic surgeons to successfully utilize procedures to help millions of patients per year accomplish restorative and aesthetic goals by performing reconstructive surgery and microsurgery to treat deformities, burns, victims of accidents and to alter physical features of the face and body.
Plastic surgery is any kind of surgical procedure used to improve or change a person's function or appearance. Once rare, and only used for victims war or severe deformity, it is becoming increasingly common as a way for people to stave off the effects of aging or to reshape themselves into something they consider more aesthetically pleasing.
It is common for people to confuse or use the terms "plastic surgery" and "cosmetic surgery" and use them interchangeably. The truth is they are very different. Physicians and surgeons require different qualifications, education, training and certification to be deemed a plastic surgeon.
If you are considering the procedure, whether medically necessary or for cosmetic enhancement, look for specialists who are trained to do the specific procedure you need or desire and also check to see if your surgeon is a Board Certified Surgeon.
It helps to know the difference between them, especially if you are a prospective patient and you are thinking of having a certain procedure done by a surgeon of either profession. Patients should know which procedures fall under which categories to keep informed of the differences between the two, and to help them in their quest for the right surgeon.
It surgery is also known as reconstructive surgery. This type of surgery involves fixing or repairing a body part or facial feature that is abnormal and is in need of reconstruction to restore its normal features. People seek reconstructive surgery or corrective surgery due to a malformation. Others may need it to resume functionality after an accident, improve health issues or correct abnormal body or facial features due to defects.
Insurance Coverage and Fees
As stated, there are those individuals who need the surgery, and those who want it. If the procedure is a medical necessity, then it will most likely be covered or partially covered by insurance. Check first with your insurance provider and surgeon to see if the type of surgery you need is medically necessary and if the provider will pay for all or part of the procedure.
If it is a personal desire, then it is considered elective, and it is not medically necessary, and therefore, not covered by insurance. In the latter case, the patient will pay out of pocket for the procedure. It can be expensive. Most surgeons offer financing options for patients who qualify to make payments with interest to select lenders who allow these options for patients with decent credit to pay for a procedure, over time.
For example, correcting a cleft lip, broken nose or birth defect falls under the category of surgery and may qualify for insurance coverage. Breast augmentation, for example, is usually put under the category of cosmetic surgery, and not covered by insurance. However, breast cancer patients may seek reconstructive breast surgery after a mastectomy or removal of breast tissue – that is considered medical procedure, and most insurance companies will cover this procedure.
Plastic and reconstructive surgery requires different certifications and education. Choosing the right kind of surgeon for your procedure will dictate outcomes, fees and even insurance claims.
In addition, insurance coverage will vary for every case. If it is medically required or approved, it may be covered by the policy or carrier, depending on the circumstances and the surgeon.
Differences Between Plastic and Cosmetic Surgery
There is not a clear definition claiming the exact requirements that distinguish a plastic surgeon from a cosmetic surgeon, but when looking for a plastic surgeon, here are some pointers to help you differentiate between surgeons who perform cosmetic surgeries and plastic surgeries:
- It is essential when shopping for a plastic surgeon that you choose one that has extensive training, background and expertise in the surgical procedure you are pursuing.
- Plastic Surgeons undergo different training to develop their expertise in certain types of surgeries of the face and body that involve more training and education to perform intricate, reconstructive procedures.
- To be fully licensed as a plastic surgeon, he or she must undergo at least five to six years of a formal residency training program in Plastic and/or Reconstructive Surgery in an accredited institution, hospital or medical center. This includes 3-5 years of general surgery residency and 2-3 years of additional residency.
- Physicians who have completed proper residency training in plastic and reconstructive surgery recognized by the proper affiliations and governing entities are the only doctors who can rightfully claim to be plastic surgeons.
- After proper training and certifications are obtained, a fully trained plastic surgeon may use the following titles depending on his/her area of specialty: Plastic Surgeon, Plastic & Reconstructive Surgeon, Aesthetic Plastic Surgeon, Cosmetic Plastic Surgeon, Facial Plastic Surgeon, Aesthetic Surgeon, and Cosmetic Surgeon.
It is noted that a qualifying-or disqualifying-factor is whether a "plastic surgeon" is a member of the American Society of Plastic Surgeons. Elite members of this plastic surgeon society must abide by the following:
- Be certified by The American Board of Plastic Surgery®
- Have undergone at least six years of surgical training and experience, with at least three years in this procedure
- Operate only in accredited medical facilities
- Adhere to a strict code of ethics
- Fulfill continuing medical education requirements
Prepare for Your Consultation with a Plastic Surgeon
It is important to understand that even plastic surgeons who board certified and members of the American Society of Plastic Surgeons can impose risks and dissatisfaction. It is in the patients’ best interest to be his/her own advocate when searching for a plastic surgeon. If you are interested in this procedure, then the first step is to research surgeons in your area and schedule a consultation to learn more about how the procedure can help you reach your surgery goals. It is best to prepare a list of questions to ask the plastic surgeon upon meeting with him/her for your consultation. Here is a list of recommended questions to ask:
- Is it the right procedure for me?
- Are there any alternatives to surgery and would you recommend any for my case?
- Am I a good candidate?
- What results should I except from it?
- What is the cost?
- How can I pay?
- Do I need additional blood work or x-rays before?
- How much experience do you have performing those procedures?
- Where will my procedure take place?
- How long will the surgery take?
- What kind of preparation do I need before surgery?
- How long will I have to stay in recovery after surgery?
- What kind of care will I need at home?
- Are there any activity limitations after my surgery and for how long?
- What symptoms should I watch out and report after my surgery?
- What medications do I need to take after my surgery?
- How long before I can go back to work after the procedure?
- How long before I can exercise again after surgery?
The New Age of Modern Plastic Surgery
There are many demands for those surgeries in modern times. Again, they range from dramatic reconstructive surgeries necessary to restore mobility, facial features and physical construct to celebrity and mommy makeovers. There are many fictitious and reality television shows representing a variety of cases and outcomes.
"Nip Tuck" is just one example of how cosmetic and plastic surgeries have become mainstream and the show magnifies the increasing popularity of it. But the Hollywood version focuses more on the lifestyles of the famous and rich and the need to go under the knife to keep up with the aesthetic expectations of a surgery centric society.
However, plastic surgeons have the power to augment and improve the quality of life for many patients who need procedures, not only in America, but worldwide. Many plastic surgeons donate their time and are affiliated with organizations that help patients from every part of the world. So for those who frown upon the profession, this procedure has influenced the lives of millions in a very positive way. Perhaps you will become one of them.
Surgery on the Rise, Despite Economy
Regardless of economic influences, those procedures have been on the rise for years. In 2010 a reported 13.1 million body parts were altered and augmented by plastic surgeons. The American Society of Plastic Surgeons (ASPS) is responsible for compiling the most comprehensive reports, and they publish them annually.
According to the American Society of Plastic Surgeons, their latest research revealed increases from 2009 to 2010 for cosmetic procedures.
Despite the economic indicators of a downturn, more patients received facelifts, breast augmentations, tummy tucks, eyelid lifts, nose reshaping, liposuction and minimally invasive procedures than in years prior.
This year, ASPS reported 113, 000 facelift surgeries in the USA in 2010, a 9% rise, which was not the case from 2007 to 2009. In addition reconstructive plastic surgeries rose 2% in 2010 from 2009. Breast augmentation procedures increased by 2%. Breast augmentation was the procedure most in demand, totaling 296,000 in 2010. Silicone implants were used in 60% of the procedures, placing silicone over saline implant options.
It is important to denote that ASPS findings only report surgeries performed by plastic surgeons. Their findings do not include procedures performed by cosmetic surgeons, dermatologists, gynecologists and trained physicians and certified clinicians, who also perform certain cosmetic and aesthetic procedures. Keeping this in mind, the number of liposuction procedures and dermal filler and Botox procedures in addition to other cosmetic treatments far exceeds the numbers below. In reality, liposuction, facial fillers and wrinkle treatments are the most popular procedures performed, worldwide.
Here is the list of the top five procedures for 2010:
- Breast augmentation, 296,000
- Nose reshaping, 252,000
- Eyelid surgery, 209,000
- Liposuction, 203,000
- Tummy tucks, 116,000
Body shaping and contouring also got a lift in percentages. An increase in all surgical body shaping and contouring procedures, such as breast, body, arm and thigh lifts occurred in 2010:
- 90,000 breast lifts, which was a 3% rise
- 10,000 lower body lifts, up 9%
- 15,000 upper arm lifts, up 5%
- 9,000 thigh lifts, up 8%
In the summer of 2010, ASPS reported the benefits of liposuction and body contouring, especially after weight loss and as a medical measure to improve cholesterol levels on certain patients. Body contouring and liposuction are very popular procedures for patients who have trouble getting rid of stubborn, excess fat. After patients lose weight, they request body contouring procedures to remove excess loose fat and tighten skin in many areas of the body.
Minimally invasive anti-aging and spa procedures to improve appearances also rose, by 5% in 2010, to nearly 11.6 million procedures. Those top five procedures included:
- Botox type A, 5.4 million
- Soft tissue fillers, 1.8 million
- Chemical peels, 1.1 million
- Laser hair removal, 938,000
- Microdermabrasion, 825,000
Ever since the FDA approved BOTOX ™ and various synthetic filler products, injectables and fillers have increased in use and remained robust over the last two years. Botox and Dysport were up 12% and fat injections were also up 14%. Fat injections and new uses of fat transfers are becoming more popular as the industry innovates on re-purposing fat in more creative ways to rejuvenate the face, breasts and body.
There are many new uses for fat transfers and stem cell re-purposing, taking the fat from one area of the body and using the good fat cells to add volume and restore other areas of the body. Patients are becoming increasingly more interested in fat transfer procedures.
Additionally, the ASPS stated that breast reconstruction rose 8% in 2010 and replaced maxillofacial surgery in the top five reconstructive procedures, which were:
- Tumor removal, 4 million
- Laceration repair, 357,000
- Scar revision, 161,000
- Hand surgery, 106,000
- Breast reconstruction, 93,000
Body Contouring, Liposuction, lipo and liposculpting, laser assisted and water assisted procedures also continued to rise in 2010.
All-in-all the number of procedures and rise in cosmetic and plastic surgeries across-the-board indicate better economic times are on the horizon.
Changing Demographics for Patients
Some of the most interesting findings in recent year have indicated demographic shifts when it comes to plastic surgery.
More and more patients are seeking procedures of every type. Now, this surgery has gained popularity across socio-economic classes, races, age groups and genders.
Women used to dominate the patient waiting list, until now. Men are increasingly seeking cosmetic surgery enhancements as a way to stay young, look great and compete in the job market.
In addition, more ethnic patients are exploring the benefits of aesthetic surgery. In 2010 more than 3.2 million procedures were reportedly performed on Hispanic, Black and Asian patients, which accounted for 25% of all patients revealing a 243 percent increase since the year 2000.
Teenagers are now the focus of cosmetic surgery debates. The dramatic increase in teen requests for surgery is concerning to parents, the media and the medical industry. Teenagers require parental consent for cosmetic procedures, if they are under the age of 18. Most teens have their personal motivations toward cosmetic enhancements, which have to do with adolescent insecurities and fears of not being accepted by peers "as is," which is also true for adults. However, the pending question is how young is too young and do their physical characteristics merit surgery. According to American Society of Plastic Surgeons (ASPS) statistics, nearly 219,000 cosmetic procedures were performed on people age 13-19 in 2010. Their most requested surgery is rhinoplasty or nose surgery.
Medical Tourism – Use Caution
To some, Americans seem obsessed with their looks, the fountain of youth and surgery procedures and they are willing to go anywhere to get it. Another growing trend is in the industry is medical tourism or traveling abroad to get a surgical procedure or makeover.
During economic downtimes, patient may think they are getting a great deal by traveling to another place to get surgery, but when it comes to your face and body, it is wise not to bargain hunt.
There is no harm in wanting it, but it is surgery, after all, and your health and well-being should be the priority.
There are many considerations when mixing travel plans with surgical procedures, such as:
- Differences in education, certification, governance and medical requirements from country to country
- Surgical devices and instruments used to perform surgeries can vary
- Hospital accreditation, sanitation and administration differences
- Liability and legal differences in cases of malpractice and recompense
- The cost of travel and hotel arrangements and accommodations
- Finding a highly recommended, trusted, reputable and qualified surgeon
- Recovery, risks and complications that can occur after surgery
- Follow up appointments require extended stay
- Receiving adequate care after surgery (patients must be cared for and monitored during recovery)
- In case of emergency, insurance and medical differences.
There are many success stories associated with medical tourism, but there are also many horror stories. If you are traveling abroad and you have friends and family who can strongly recommend a qualified surgeon, and if they are willing to help you through the healing and recovery process, then you may be on to a better you, but use caution if medical tourism is in your future plans. In addition, if you are considering medical tourism or going abroad for your surgery, inform yourself of the surgical experience and requirements, expenses, facilities, differences in laws, wrongful death and insurance issues. It is always better to be safe than sorry or to have to repeat a surgical procedure upon your return home.
Best Approach to the Surgery
There are many advances made in the cosmetic surgery industry, every year. Now more than ever, surgeons can deliver more refined and precise results. The better and more experienced the surgeon, the better the outcome for the patient. Keep in mind, surgeons are "employees" of their patients. It is up to surgeons and patients to use common sense as a guide to get natural and realistic results from each surgery. It is unfortunate when patients do not understand the limitations or excesses that may come with it.
Patients need to work within the framework or physical construct of what they have, naturally. So, a doctor can only do so much surgically to surgically enhance your appearance. Good surgeons will always consider the blueprint they have to modify, just like good architects. Cosmetic and plastic surgeons are craftsmen/women. It is like fine art, only they are dealing with living beings.
It is imperative for patients to keep sight of their natural beauty and authenticity in the process of augmentation. Some parts will look much better with surgical work, others may just as well be left alone.
Face Lift: The traditional face lift is the most popular, but now there are new face lift procedures that are not as invasive and reveal beautiful, natural results. There are mid-face lifts that pull back the lower region, jaw and neckline and do not look too pulled-back. The traditional "face lift" procedure is one of the most notoriously easy to spot procedures out there. The face can be lifted and tightened through different procedures, so ask your surgeon which procedure is best for you, your features and your bone structure.
Eyelid Lift: Otherwise known as a blepharoplasty, this is a surgical procedure to modify the eyelids and trim away sagging, drooping lids, and lift the area around the eyes. There is a big difference between the outcome of a natural looking eye lift surgery and one that results in eyes that appear too wide or open. A skilled surgeon can perform this surgery with ease and make your eyes look natural and youthful, instead of miss-shaped and "surprised."
Breast Surgery: Breast augmentation and reconstruction are the most common plastic surgeries. There are many reasons women have their breasts augmented, lifted, reduced and reconstructed. There are plenty of photos and examples of bad breast surgeries to help patients determine a size and shape that fits their frame, realistically. A good surgeon will guide patients to the right size and technique to achieve balance. Now there are natural breast augmentation surgeries, fat transfers and various implants to have a fuller, more natural bust-line.
Tummy Tuck: The tummy tuck is a common procedure performed mostly after extreme weight loss or after women have had children. Many women request a tummy tuck as a part of a mommy makeover. Women and men, who are uncomfortable with their bulges and excess weight in their mid-sections have the fat and flab trimmed away during this procedure. A tummy tuck can help people achieve a more proportionate body and get rid of unsightly fat to trim their waists and love handles. Typically a tummy tuck requires specific surgical techniques and liposuction. Finding the right surgeon for your tummy tuck is the key to your desired outcomes.
Rhinoplasty: Since the nose is the center point of our face, we tend to focus on its shape and proportion, and how it impacts the profile. Any good nose job requires a great surgeon to avoid a pinched or unnatural look. Keep in mind that it is important to maintain some authenticity when getting this surgery. Getting too much shaved off can make your face look just as dis-proportionate as having too big of a nose. Before having this surgery, take your time to look at many photos and find the right surgeon.
Always plan ahead, and tell a friend or family member that you are having a surgical procedure. Assign someone to your well-being, until you are back on your feet.
Locate a Plastic Surgeon Near You
Plasticsurgeryusa.com has made finding a plastic surgeon near you easy. Just use our search section or click on a state on the map. A list of surgeons in the selected area will be displayed.
Search until you find the right surgeon with the proper credentials and experience. Ask questions, look at before and after photos, and visit and consult with surgeons, until you find the one that makes you feel confident in your decision to move forward.