cosmetic surgery
Operations on the face |
Forehead lift: tightens the forehead and raises the brow |
Facelift (rhytidectomy): tightens the jowls and neck |
Eyelid tightening (blepharoplasty): tightens the eyelids |
Rhinoplasty (nose job): changes the appearance of the nose |
Otoplasty (ear pinback): brings the ears closer to the head |
Facial implants (chin, cheek): makes the cheek or chin more prominent |
Hair transplantation: treats male pattern baldness |
Scar revision: improves the appearance of scars |
Skin resurfacing (laser, peel, dermabrasion): smoothes the skin |
Operations on the body |
Breast enlargement: enhances the size of the breast |
Breast tightening (mastopexy): tightens the skin of the breast |
Breast reduction: reduces the size of the breast |
Breast reconstruction: rebuilds the breast after cancer |
Abdominoplasty (tummy tuck): tightens skin and removes extra fat |
Mini-abdominoplasty: removes the lower abdominal pouching |
Liposuction: removes extra fat |
Arm lift: tightens the skin of the upper arm |
Gynecomastia resection (large breasts in men): reduces breast size |
It is, of course, evident that virtually all procedures which could be conceptualized as cosmetic or aesthetic can also have a reconstructive dimension. Breast reconstruction, which used the same type of implant as breast augmentation, was the focus of a major debate within both medical and feminist circles in the US in the 1990s, as to whether it was reconstructive or aesthetic surgery. During the closing decades of the twentieth century these procedures, and also aesthetic orthodontics, came to be a common undertaking. Aesthetic surgery became a focus of interest — being patient-initiated, and non-reimbursable by private or state third-party payers.
While aesthetic surgery is related in many ways to other physical interventions, from hairweaving to tattooing and body piercing, it is performed in the quite different context of the institution of medicine. The surgical interventions are understood by doctors and patients alike as aesthetic rather than reconstructive. Even though the term ‘aesthetic surgery’ was acknowledged only recently, the practice of surgical interventions devoted to making people ‘beautiful’ rather than to any direct reconstruction of physical anomalies is relatively recent. There is a necessary if rather arbitrary distinction between reconstructive (plastic) surgery and aesthetic (cosmetic) surgery — between not having a nose and having a nose that you dislike. The first represents a functional fault. There is something wrong with the body as well as an unfortunate appearance — a hare lip, a missing jaw, a lost ear — and your desire is to repair the function of the body. Part of that function is, of course, an aesthetic one. Cosmetic surgery, which is part of, and grew from, reconstructive surgery, stresses the latter, subordinate, but essential aspect of the reconstruction. We imagine our bodies as intact and read our intactness as ‘beauty’. You may have a functional nose, a jaw, a breast, but it does not represent your self-image of the beautiful nose, jaw, or breast. It inhales, chews, or lactates, but it is not appropriate. The distinction between reconstructive and aesthetic surgery is an arbitrary one. Certain interventions have been labelled as inherently different — such as breast reconstruction vs. breast augmentation, even though the procedures are similar. The former are understood as a means of restoring physical completeness to the body image and therefore of restoring the psyche to a ‘happy’ state; the latter can be dismissed as ‘vogue fashions’ ( R. V. S. Thompson, Kay-Kilner Prize Essay, 1994). Feminists in the 1990s, such as the American poet Audre Lorde, who underwent a radical mastectomy, argued against breast reconstruction as a refusal to acknowledge the realities of the woman's body. In the Middle Ages, Guy de Chauliac, perhaps the most important surgeon of his time, defined the role of surgery as being threefold: solvit continuum (separating the fused), jungit separatum (connecting the divided), and exstirpat superfluum (removing the extraneous). There is no discussion in his or other texts of that period about the creation of new body parts or their augmentation or reconstruction, although it is evident that virtually all primarily reconstructive surgical procedures also had an aesthetic dimension, even then. As early as the Edwin Smith Surgical Papyrus (3000 bce), surgeons were concerned about the cosmetic results of their interventions. The Egyptians were careful to suture the edges of facial wounds. Even fractures of the nose-bones were dealt with by forcing them into normal positions by means of ‘two plugs of linen, saturated with grease’ inserted into the nostrils. The Roman physician Aulus Cornelius Celsus stressed the ‘beautiful’ suture. This approach can be followed through to the late nineteenth and early twentieth century, with plastic surgeons such as Erich Lexer stressing the cosmetic ends of an operation as ‘an always more appreciated requirement of modern surgery’. Such a stress on the neatness and beauty of the closure was part of the image of the return to function following the operation, for the beautiful was a sign of the healthy — but of the healthy body, not the healthy mind.
Yet even as we understand aesthetic surgery as a means of altering our body's ‘image’ it becomes a means not only of changing our bodies but of shaping our psyches. Aesthetic surgery remains rooted in a presumed relationship between the body and the mind. Sculpting the body comes to be a form of reshaping the psyche.
The central assumption of aesthetic surgery is that if you understand your body as ‘bad’ you are bound to be ‘unhappy’. And in our day and age, being unhappy seems to be identified with being sick. And if you are sick, you should be cured! The idea that you can cure the soul by altering the form of the body became commonplace in the twentieth century. It is the other side of the coin from the argument that to cure specific bodily symptoms you need to ‘heal’ the psyche.
Elaine Scarry has remarked in her classic work The Body In Pain (1985),
… at particular moments when there is within a society a crisis of belief — that is, when some central idea or ideology of cultural construct has ceased to elicit a population's belief either because it is manifestly fictitious or because it has for some reason been divested of ordinary forms of transubstantiation — the sheer material factualness of the human body will be borrowed to lend that cultural construct the aura of “realness” and “certainty”.
It is this realness and certainty ascribed to an imagined as well as the real body which is operated upon by the aesthetic surgeon.
During a period of revolutionary change in science, from the mid nineteenth to the early twentieth centuries, two major developments took place which enabled surgeons to introduce aesthetic changes, and patients to overcome their anxiety and undertake such procedures. Antisepsis and anaesthesia became central to the practice of surgery, following the discovery of ether anaesthesia in 1846 and the development by the 1880s of local anaesthesia. The movement toward antisepsis paralleled the development of anaesthesia: the model for antisepsis provided by Joseph Lister in 1867 became generally accepted by the end of the century. Aesthetic surgery became a context in which the ideology of the medical alteration of the body (and its state) was accepted by both the patient and the physician. All of these concerns can be understood as concerns of ‘hygiene’ in the broadest nineteenth-century sense, a hygiene of the state of both the body and the psyche. This set the stage for the development of the procedures used today. Take the case of Jacques Joseph, a young German-Jewish surgeon practising in fin-de-siècle Berlin. In 1896 Joseph undertook a corrective procedure on a child with protruding ears (otoplasty), which, although successful, caused Joseph to be dismissed from the staff of the orthopaedic clinic at the Berlin Charité. One simply did not undertake surgical procedures for vanity's sake, he was told upon his dismissal. The child was not suffering from any physical ailment which could be cured through surgery. Yet, according to the child's mother, he had suffered from humiliation in school because of his protruding ears. It was the unhappiness of the child that Joseph was correcting. The significance of protruding ears was clear to Jacques Joseph and his contemporaries at that time. There is an old trope in European culture about the Jew's ears that can be found throughout the anti-Semitic literature of the fin de siècle, and it is also a major sub-theme of one of the great works of world literature, Heinrich Mann's Man of Straw (1918). In that novel, Mann's self-serving convert, Jadassohn (Judas's son?) ‘looked so Jewish’ because of his ‘huge, red, prominent ears’ which he eventually went to Paris to have cosmetically reduced; his ears signified his poor character. Jacques Joseph went on to pioneer the intranasal procedure for the reduction of the size of the nose and came to be known among the Jewish community in Berlin as ‘Nose-Joseph’.
The social and psychological significance of the introduction of aesthetic surgery is relevant to other external markers of difference, from ageing (face lifts), to sexuality (transsexual surgery), to notions of beauty of face (orthodontics) and of body (liposuction). The norms of the acceptable change with time, but the desire to become invisible, to become a member of a class or group to which one does not naturally belong, maintains itself over the entire history of aesthetic surgery.
Sander L. Gilman
Bibliography
Gilman, S. L. (2000) Making the body beautiful: a cultural history of aesthetic surgery. Princeton University Press, Princeton.
Maltz, M. (1946). Evolution of plastic surgery. Froben Press, New York.
Wallace, A. F. (1982). The progress of plastic surgery: an introductory history. Willem A. Meeuws, Oxford.
Cosmetic Surgery
Cosmetic surgery
Definition
Cosmetic surgery is a medical procedure that alters normal structures of the body for cosmetic reasons.
Purpose
Cosmetic surgery is plastic surgery that is done for solely cosmetic reasons. Plastic surgery done for medical reasons is called reconstructive surgery. Cosmetic surgery can change a body part that an individual is unhappy with, such as a nose believed to be too large, or can be done to correct signs of aging. There are many different types of cosmetic surgery, and the purpose of the particular procedure depends on the goals of the patient.
Some of the more common cosmetic surgery procedures include:
- Face lift (rhytidectomy)–performed to reduce signs of aging in the face and neck.
- Eyelid surgery (blepharoplasty)–performed to correct sagging eyelids, excess skin around the eyes, or bags under the eyes.
- Nose surgery (rhinoplasty)–performed to reshape the nose.
- Forehead lift-preformed to reduce frown lines and forehead wrinkles and raise the eyebrows.
- Breast augmentation-performed to increase the size of the breasts.
- Breast lift-performed to tighten, firm, and raise the breasts.
- Tummy tuck (abdominoplasty)–performed to remove excess adnominal fat and create a tighter, thinner looking abdominal area.
- Spider vein removal (sclerotherapy)–performed to remove spider veins, usually on the legs or face.
- Liposuction-performed to reduce excess fat deposits.
Precautions
Cosmetic surgery is a procedure that is not medically necessary, but that carries all of the risks of any surgery. Therefore, it is important that individuals carefully consider whether the results of the procedure justify the associated risks. Any underlying health problems can increase these risks significantly. Individuals with heart or cardiovascular problems, type 2 diabetes, who smoke, or drink alcohol are also at an increased risk of complications and are also likely to have a longer than average healing time. Smoking also increases the likelihood of scar formation.
Description
During cosmetic surgery the surgeon makes an incision to expose the area to be operated on. The actual steps of the procedure vary dramatically form one procedure to another. The process is different for different parts of the body, and for different desired outcomes. For some procedures, such as nose surgeries, the surgeon restructures the nose itself. This can occur by removing some of the cartilage form the nose, such as to reduce nose size or remove bumps form the nose, or by adding mass to the nose, such as to increase the size of a very small nose. The cartilage is reshaped and then the skin over the cartilage is replaced.
In the case of breast augmentation or breast lift, an incision is made in the chest to expose the breast tissue. In the case of breast augmentation implanted sacs of saline or other materials are placed behind the breast tissue, and the skin is stretched to closed to cover. During breast lift some breast tissue may be removed or tightened, and skin covering the breast may be removed or tightened.
During procedures on the face incisions are usually made at the hairline or in the natural crease of the eyelid whenever possible to minimize the chances of visible scarring. The surgeon may remove material from the face, remove excesses skin, remove fat deposits, or redistribute material to tighten the skin, define the jaw line, and reduce the appearance of bags under the eyes.
Preparation
The doctor will instruct the patient to stop taking certain medications, supplements, or herbs, especially those that increase the likelihood of bleeding, before the procedure. Individuals may be instructed to stop smoking and drinking alcohol. The patient may be asked to refrain from eating or drinking anything for a certain number of hours before the surgery. Before the surgery the patient will have many meetings with the doctor and his or her staff to discuss what aftercare will be required and to ensure that the patient is a good candidate for the procedure both emotionally and physically. The doctor will usually make markings on the patient using a marker or other writing device to show where incisions will be made prior to patient being in the operating room.
Aftercare
The aftercare required for cosmetic surgery varies depending on the procedure performed. The doctor and other members of the health care team will give the patient specific instructions relevant to his or her procedure. In general, aftercare starts in the recovery room as the patient wakes up form the general anesthesia . His or her heart rate and other vital signs are monitored as the anesthesia begins to ear off.
At home, additional aftercare is often required. Medication may be prescribed to help manage pain. Antibiotics may be prescribed to help prevent infraction at the surgical site. Swelling and bruising occur for most procedures for two to four weeks after the surgery. This may be longer for seniors, as healing can slow with increased age. Assistance may be required for certain tasks depending on the type of procedure performed. Procedures around the eyes can cause swelling significant enough to temporarily interfere with eyesight, so assistance with driving may be required. If the procedure was performed around the mouth chewing may be difficult or painful until swelling subsides, so mushy or liquid foods may be preferred. For most procedures one or more follow-up visits to the doctor are required to ensure that healing is progressing normally and no complications are detected.
Complications
There are serious complications that are possible from any surgical procedure. The specific complications possible from cosmetic surgery depend on the procedure being performed. However, in general they include infection, bleeding, excessive swelling, bruising, and scarring. Theses complications are more likely to occur in individuals who are not in excellent health before the procedure and those who smoke. To help prevent complications the doctor may instruct the patient to stop smoking, stop drinking alcohol, or temporarily stop taking certain medications prior to the procedure. Most cosmetic surgeries are performed under general anesthesia. General intestinal has its own risks of serious complications including heart attack , stroke , abnormal heart rhythm, and even death . Individuals with certain health problems may be at increased risk for these compilations. Seniors may be at increased risk for serious compilations of cosmetic surgery and general anesthesia as well as for increased healing times.
Results
The results of a cosmetic surgery will vary depending on the type of procedure performed. In most cases the result is an improved or more youthful appearance. The full result of the procedure is often not visible for one to two months after the surgery. For procedures such as liposuction the full result of the procedure may not be visible for a s long a six months. Incision lines created by the procedure may continue to fade for a year or more after the surgery. For many procedures the swelling and bruising caused by the surgery fades over two to four weeks after the procedure.
Results from cosmetic procedures are not always permanent. Although spider vein surgery removes the targeted spider veins completely, spider veins may reappear in the same are requiring additional surgery.
Procedures done to improve the youthful appearance of the face may need to be repeated as the skin of the face continues to sag slowly over time and collagen and other materials of the face are depleted. Devices implanted during breast augmentation often must be replaced eventually, and yearly visits to the doctor are recommended to check to see if replacement is required. Liposuction removes fatty deposits form the body but through unhealthy lifestyle they can be redeposited over time and further surgery may be desired.
Caregiver concerns
There are a variety of health care professionals who may play a role in cosmetic surgery. The surgery itself should be performed by a doctor who is board certified in plastic surgery by the American Board of Plastic Surgery in the United States or the Royal College of Physicians and Surgeons of Canada in Canada. The doctor is assisted by a variety of nurses and other health care professionals before, during, and after the surgery.
One or more nurses will generally assist the patient in preparing for surgery. He or she will explain to the patient any necessary steps, such as not eating or drinking, that must be taken leading up to the surgery. He or she will also help make sure the patient understands what is going to happen during the surgery and what the expected recovery time will be. During the surgery nurses, surgical technologists, and others may be present to help the doctor performing the procedure. An anesthesiologist will be present for any procedures that require general anesthesia to administer the anesthesia and to monitor the patient during the procedure.
After the procedure has been performed successfully a recovery room nurse will help the doctor
QUESTIONS TO ASK YOUR DOCTOR
- Are you board certified?
- How long have you been practicing?
- How often do you perform this type of procedure?
- What results can be realistic expected?
- What is the expected recovery time required for this procedure?
- How will the results of this procedure last over time?
monitor the patient as he or she wakes up and the anesthesia begins to wear off. The nurse will also explain to the patient or the patient's caregiver what steps are necessary for recovery at home , and explain the purpose of any prescribed medications and how often they must be taken. A nurse may also assist the doctor during any follow up visits by taking patient information about discomfort and recovery, and taking blood pressure or performing a preliminary check of the surgery site for problems and passing this information on to the doctor.
Resources
BOOKS
Arroyave, Efrain. Understanding Cosmetic Procedures: Surgical and Nonsurgical. Clifton Park, NY: Thomson Delmar Learning, 2006.
Hodges, Andrew. A-Z of Plastic Surgery. New York: Oxford University Press, 2008.
Loftus, Jean M. The Smart Woman's Guide to Plastic Surgery, 2nd ed. New York: McGraw-Hill, 2008.
PERIODICALS
Coleman, William. “Straight Talk About Cosmetic Surgery.” Dermatologic Surgery 34.2 (February 2008): 238.
Malick, Farah, Josie Howard, and John Koo. “Understanding the Psychology of the Cosmetic Patients.” Dermatologic Therapy 21.1 (January 2008): 47–54.
Swami, Viren, et al. “Looking Good: Factors Affecting the Likelihood of Having Cosmetic Surgery.” European Journal of Plastic Surgery 30.5 (February 2008): 211–219.
ORGANIZATIONS
American Society for Aesthetic Plastic Surgery, 11081 Winner Circle, Los Alamitos, CA, 90720-2813, (888) ASAPS-11, www.surgery.org.
Helen Davidson
Cosmetic Surgery
COSMETIC SURGERY
COSMETIC SURGERY, like reconstructive surgery, has its roots in plastic surgery (coming from the Greek word "plastikos," meaning to form or mold), which is the repair, restoration, or improvement of lost, injured, or misshapen body parts. Records of plastic surgery are found as early as 800 b.c. Unlike reconstructive surgery, cosmetic surgery is performed solely for reasons of enhancing appearance. Most consider the sixteenth-century Italian Gasparo Tagliacozzi the father of plastic surgery. Tagliacozzi was a pioneer in nasal reconstruction, often repairing damage from a brawl or duel. Another pioneer was Charles C. Miller, considered the father of modern plastic surgery. Operating in the early twentieth century, Miller published numerous works on improving a person's appearance. Plastic surgery remained a small and obscure area of medicine until World War I. Trench warfare caused facial wounds so frequent and severe that special groups of doctors were formed to deal with facial injuries. Among the volunteer doctors were two Americans, Varaztad Kazanjian and Vilray Blair, who were instrumental in developing new techniques and sharing their knowledge after the war. By 1921, plastic surgeons holding both medical and dental degrees organized into the American Association of Oral and Plastic Surgeons; in 1941 the name was changed to the American Association of Plastic Surgeons. The American Society of Plastic and Reconstructive Surgeons was formed in 1931, followed by the American Board of Plastic Surgery in 1937.
BIBLIOGRAPHY
Haiken, Elizabeth. Venus Envy: The History of Cosmetic Surgery. Baltimore: Johns Hopkins University Press, 1997.
Lisa A.Ennis
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