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Cosmetic Surgery

Cosmetic Surgery

A High-Tech Answer to Aging

Is it still a secret rite of the Beautiful People? Hardly. Any woman may consider a surgical solution to unwanted signs of aging. And a lot of them are--at earlier ages than you might expect.

"We have a youth-oriented, physically fit society," says Alan Matarasso, M.D., a plastic surgeon at the Manhattan Eye, Ear and Throat Hospital. "Every time you see a cola commercial with a 12-year-old girl dressed up to look like an adult, that subtly increases the pressure on all of us."

Many women are fascinated by the idea of turning back the clock surgically, Dr. Matarasso says. "Anyone who's ever looked in the mirror and been concerned about getting older will consider it at some point."

"All the same, we should never take it lightly," Dr. Matarasso says. "For certain people, cosmetic surgery wouldn't be right."

If you're more than just curious, it's important to recognize first what cosmetic surgery will not do. It won't turn you into a supermodel or make you the life of the party. It may make you look younger, but you'll need realistic expectations of the outcome, as well as money, since most health insurance plans cover only part of the bill.

And be sure you're not opting for the scalpel when a more conservative treatment might do. The fine lines and blotchy texture caused by moderate sun damage can be treated very effectively in a dermatologist's office. She may offer you light chemical peels, dermabrasion, wrinkle-filling injections or a prescription for the popular wrinkle-eraser, tretinoin (Retin-A). (For tips on these approaches, see Wrinkles, chapter 67.)

But you may be distressed by more significant changes in your appearance. Heredity, serious sun worship, repeated lose-and-gain-it-back diets or just the years of yielding to gravity may have caused deep wrinkles, a pouchy jawline, a sagging neck or baggy eyelids. In these cases, you may wonder about cosmetic surgery.

Surgical techniques have been refined and simplified over the years, and most cosmetic procedures involve a lot less trauma than they used to. Sometimes a local anesthetic is all that's needed, or tranquilizers plus a local to put you in "twilight sleep"--a sort of dozy fog you hardly remember afterward. Recovery times are shorter than they used to be, but they vary widely depending on the individual, the procedure and the surgeon. Any discomfort is easily handled with analgesics, surgeons say.

Resculpting the Face

Forget the tight masks of Hollywood fame. Today's cosmetic surgery can offer very natural-looking, subtle corrections for many age-related changes. Here's what it can do.

Lift a weary brow. When your forehead muscles slump, you can look tired all over. A forehead lift will smooth a slouching brow and ease deep crow's-feet and frown lines, says Dr. Matarasso. "This procedure is virtually painless," he says. "All stitches are hidden in the hairline, and though you may have swelling along the cheeks and some bruising, you could go back to work in 48 hours."

Banish baggy eyes. You're not feeling tired, but bags under the eyes or sagging lids may make you look that way. Eye surgery called blepharoplasty offers the most dramatic change of all cosmetic surgery procedures, says Michael Sachs, M.D., a plastic surgeon in private practice in New York City. Though the under-eye work is usually done with a scalpel, he has developed a simpler method called fat-melting blepharoplasty. Using a heated probe and a tiny incision, the surgeon vaporizes the water content of the fatty pouches, melting away eye bags instantly. Saggy upper lids can be partially corrected with the fat-melting technique, Dr. Sachs says, but excess skin on upper lids must still be surgically trimmed.

Shape the nose. Nowadays most nose repairs (rhinoplasties) are done without fracturing the bone, Dr. Matarasso says. The results of today's rhinoplasties are much more natural than the piggy-looking, scooped-out, turned-up and pinched-in look common in the sixties. Some of the changes of aging, such as the nose drooping toward the upper lip or thickening at the tip, are corrected with delicate sculpting of the cartilage from incisions inside the nose, he says.

Smooth a sagging jawline. Where bone has thinned along the jawline, the overlying skin may begin to sag. A solid silicone implant can be inserted from a small incision within the mouth, says Geoffrey Tobias, M.D., a plastic surgeon at Mount Sinai School of Medicine of the City University of New York. The implant firms the jaw profile, giving skin a less jowly drape and a smoother line. "These implants are solid and do not contain the liquid silicone that caused problems in the past," Dr. Tobias says. "The solid implants don't budge."

Find the fallen apples. Solid silicone implants may also be used to fill out hollow cheeks. Whether you exercise fanatically or are just naturally on the slim side, you may have discovered that the "apples" of your cheeks are vanishing as you age, leaving gaunt hollows. If these mid-face depressions make you feel haggard rather than fit and lean, consider the implants, Dr. Tobias says.

Lift the face. Ever tugged your facial skin up and back to see what a face-lift might do? You looked younger in the mirror, sure, but also sort of stiff. A stretched-looking face-lift used to be the norm, but techniques have changed, with gratifyingly natural results. "In the past, they'd tighten only the skin, which gave that masklike look," says Dr. Matarasso. "Now face-lifts are customized to each person's anatomy. Sometimes we hardly pull the skin and just work underneath, removing fat and tightening the layers of muscle to give a youthful jawline."

Firm the neck. A lower face-lift concentrates on a sagging neck or double chin, says Dr. Matarasso. The surgeon removes excess skin, tightens cords of muscle and removes fat to resculpt the chin into a firmer shape. "Stitches are hidden behind the ear," he says. "Some people just have the neck lift, and some do both the neck and face."

What about the Rest of You?

If you're a mother, you may have special body concerns as you age, says Dr. Matarasso. Though many bodies droop with age, the sag is especially noticeable after childbirth. Both breasts and abdomen are stretched by pregnancy, and in some women the skin stays lax afterwards. The glandular structure of the breasts loses volume, and they may sink considerably. And that rounded belly? Women lack a muscle fascia, or covering, in the lower abdomen. The stresses of pregnancy increase this weakness tremendously, Dr. Matarasso says, producing a hard-to-flatten bulge. Here's what can be done.

Restore youthful breasts. Plastic surgeons define a youthful breast as one with the nipple "at or above the lower breast crease when viewed from the side," Dr. Matarasso says. During a breast lift, incisions are made in the crease beneath the breast and around the outer edge of the nipple. The surgeon tightens the gland and removes excess skin during the procedure, which is generally performed on a outpatient basis, he says. You'll be asleep with the same kinds of anesthetic gases used during some dental procedures, he says.

If your quest is breast enlargement, the path is paved with painful questions in the aftermath of the serious debates over liquid silicone implants. While experts continue to evaluate silicone's safety, saline implants are still available.

Flatten the abdomen. Popularly called the tummy tuck, there are really four types of abdomen-flattening surgeries, Dr. Matarasso says. A fat-suctioning technique called liposuction actually removes stubborn pockets of fat. A mini-abdominoplasty uses liposuction along with a pubic-hairline incision (the same often used for Caesarean births) to tighten muscles and remove a wedge of excess skin. A modified abdominoplasty uses a bikini-line incision to correct pouching or fullness above and below the navel. And if the entire abdomen is to be treated, the surgeon will extend the bikini line incision several inches at both ends. (For tips on liposuction, see "Is Liposuction for You," chapter 17.)