by Lauren McLemore and Lisa Fischer
From well-known laser hair removal procedures and BOTOX injections to the reconstruction of entire body parts, the industry of cosmetic and plastic surgeries includes a wide range of services — some of which aren’t even surgeries at all. While it might be easy to equate plastic surgery with wealthy models and Hollywood stars, today’s technologies have made a large number of these procedures more accessible and affordable than ever. The culture of plastic surgery has a long-standing reputation of being a way for people to enhance their features to attain a certain look, but there is so much more to these surgeries than just liposuction and tummy tucks.
Before going any further, it’s important to note that there is a difference between plastic and cosmetic surgery, both of which we will discuss in this article.
Plastic surgery is a medical field that encompasses plastic and reconstructive surgery. It is recognized as a specialty by the American Board of Medical Specialties and becoming a plastic surgeon requires rigorous medical and surgical training.
Cosmetic surgery is a type of surgical procedure that is elective and performed by a medical doctor who also has received rigorous medical and surgical training. Cosmetic surgeons can be plastic or reconstructive surgeons. Both specialities can be board certified. Some physicians prefer the title “cosmetic” surgeon but may be plastic surgeons. Both of these disciplines are important. It is up to you to choose which of these physicians in the right one for you. But how do you make that decision?
In a word: research. Suzanne Yee, M.D., says “reputation, experience and passion about what they do are characteristics people should look for” in their surgeon. She emphasizes, “Experience plays a big role.” Talk to your peers. Do your due diligence on the internet. Word of mouth is important and knowing a physician’s credentials is, too. This goes for other appearance improvement artists as well such as dentists, aestheticians and those in the field of prosthetics who can help restore the old you.
Let’s start with the windows to the soul, the eyes. Byron Wilkes, M.D., is the oculofacial plastic surgeon at McFarland Eye Care and when it comes to your eyes, he says, Lower and upper blepharoplasty is the procedure that removes bags and fat under and above the eyelids with a fairly simple in-office procedure with minimal downtime. “Every patient is different, but we say the patients need 5-7 days when they not perform strenuous activities. It helps keep bruising at minimum. And it’s an easy ask for patients.” He adds that if patients are concerned with both uppers and lowers, “Do it at the same time, one anesthesia, one healing process.” Does insurance cover this? “If you have a visual field impairment, insurance will cover it.” Some patients knock it all out at once with a forehead lift which is for cosmetic purposes. He says, “It gets the fatty tissue from the eye socket along with a sagging brow.” Some patients need both procedures to get the best outcome.
When any cosmetic or reconstructive procedure meets the criteria as medically necessary, insurance will likely cover the surgery. Besides the eyelid lift, other common surgeries fall into this category, such as procedures to correct nasal airway obstruction and breast reduction.
Reconstruction of the body, including elective cosmetic changes, can enhance multiple areas of patients’ lives beyond the mechanical benefits, many times increasing their confidence and self-esteem. Psychological, emotional and vocational function are all also highly affected by appearance.
Dental surgeon Lee Wyant, D.D.S., works with many different types of patients at Smile Arkansas, a dental office in which the cosmetic options range from whitening to no-prep veneers. Wyant says that for many patients missing teeth, dental issues that affect speech and other aspects of a less-than-perfect smile can affect things outside of mere self-esteem — such as searching for a job.
“People evaluate you on your looks like how you dress, how you speak. If you’re missing teeth or have gaps in your teeth, people can tend to judge more harshly,” Wyant says.
Dental imperfections can also affect daily functions including chewing which can have a major impact on both personal and social life. Across the board, though, Wyant says that even patients who are having a procedure done for a functional reason almost always want the solution to look natural.
“Many times I have patients who, when they come to have their smiles changed any, they’ll request specifically that their teeth look nice; they don’t want to look like they’ve had their teeth done,” says dental surgeon DJ Dailey, D.D.S., of Smile Dailey.
The desire for a no-work-done appearance spills over into the traditional plastic surgery setting where just as many patients are requesting procedures that are natural-looking. Aesthetic plastic surgeon Michael Spann, M.D., at Little Rock Plastic Surgery offers many of the common cosmetic procedures such as breast augmentation, breast lift, abdominoplasty and liposuction. Spann says that, in his field, patients now have access to procedures that allow for more natural outcomes.
Luckily, technology has made way for a number of new procedures, many of which are noninvasive or, at the least, much safer than they were previously. However, in the end, the procedure itself is only a small part of the investment. Even though there are so many options that can provide natural-looking results, AY publisher Heather Baker knows the importance of ensuring that you are prioritizing quality, even for something as simple as fillers.
“Everyone has the same products,” Baker says. “It’s who does the injections that is 100 percent the key.”
Bruce Sanderson, M.D., the practicing physician at Lasercare Skin Clinic, has been an internal medicine specialist and diagnostician in Arkansas for more than 40 years. The clinic offers face and body treatments, including SculpSure, tattoo removal, anti-aging treatments, acne treatments, BOTOX, body contouring, microneedling and skin tightening treatments. Having studied under cosmetic dermatologists and plastic surgeons in both Los Angeles and New York, as well as having attended Harvard University seminars on the topic, Sanderson makes a point to stay up to date with advancements in cutting-edge technology. But no matter how popular the procedure, he won’t use anything that puts his patients at risk. He believes that while new technology is exciting, it should never outweigh the security of knowing that you have the most qualified professional working on you.
“I don’t put my patients at risk, period. I’m just [remembering] that old Hippocratic Oath we took; the first thing is to ‘cause no harm.’ Particularly over something cosmetic, I see no reason to jeopardize someone’s health or set them up for possible scarring,” Sanderson says.
The risks are also present in less invasive procedures.
“There are some risks with even laser treatments if they’re not done correctly, and I make the clinical decisions about the treatment plan for each patient, and then I fire the lasers,” Sanderson says. “Most of my patients appreciate the fact that a physician is firing the laser on their face or body.”
Anne Trussell, M.D., also has a background in internal medicine, having been in a private internal medicine practice for 20 years before opening Sei Bella Med Spa, which offers services for age management, body contouring and fat loss, along with hormone therapy. Two aestheticians and a massage therapist work in the spa. She, too, cited the Hippocratic Oath as a determining factor in deciding how and what treatments to provide.
“Just because somebody will pay for a service, it doesn’t mean you [always] want to do it. You need to offer them the safest choices possible,” Trussell says. “The goal is not really to change how someone looks; it’s to restore how someone used to look.”
Trussell’s hormone therapy is a unique service that can be life-changing for people battling things like symptoms of menopause, hot flashes, night sweats, fatigue and low libido, but it isn’t something she would give to just anyone.
“I wouldn’t give someone bioidentical hormones if their labs and their symptoms didn’t warrant them getting them,” Trussell says. “There needs to be a reason there.”
Knowing that your provider has your best interest in mind is a big part of deciding which clinic or surgeon to seek out for your procedure. Sometimes, though, it is just a matter of choosing one procedure over another because it better fits your lifestyle.
“A lot of people that I see, they work, and they can’t afford the downtime that would come with a surgery,” Trussell says.
Dr. Yee of Cosmetic & Laser Surgery Center agrees that being in the workforce plays a big role in getting these procedures.
“Many people are staying in the workforce for many more years,” Yee says. “To continue to be competitive, more and more people are getting surgical and nonsurgical cosmetic enhancements to continue to look refreshed and lively.”
Some of these nonsurgical procedures include things like body sculpting.
“We now have Emsculpt that can actually build muscle and also reduce fat without surgery,” Yee says. “It is the first one of its technology that is out on the market that can help build your muscle without having to break a sweat. Also, we have CoolSculpting that can reduce fat nonsurgically by selectively freezing fat [but] not destroying any of the surrounding tissue. The temperature is specific for fat and targets fat to permanently reduce [it].”
A common goal among youth-defiers is affordable options with little downtime. “When I was training, BOTOX was not used for treating wrinkles; the only filler was collagen. Now there are dozens of fillers,” says plastic surgeon Gene Sloan, M.D., at Aesthetic Plastic Surgery in Little Rock. “Those are quick, easy, no-downtime procedures, and they’re much more affordable.”
While the stigma of elective surgery might always be lurking, these surgeons are convinced that the popularity is growing, the technology is expanding, and the culture is seemingly changing.
Plastic surgeon W. Tomasz Majewski, M.D., of Majewski Plastic Surgery in Jonesboro specializes in cosmetic surgery, facial rejuvenation, cosmetic and reconstructive breast surgery, body contouring and reconstructive surgery after skin cancer removal.
He and many other practitioners — dental surgeons included — believe that patients are much more educated today than before about their options, the treatments and the risks. In fact, many of them are even more open about their experiences.
“Perhaps it’s because social media has given us a ‘behind the scenes’ look at how celebrities achieve their ‘natural’ beauty — but plastic surgery seems to be less of a taboo topic than it once was,” Majewski says.
Natural looks are much more achievable now than they used to be. Majewski says that the move away from “can’t-recognize-her” makeovers is a major part of the shift.
“Most of the cosmetic patients I see aren’t looking for dramatic changes — just small, ‘tweak-ments’ to help them feel more confident in their skin. I think once you see how subtle, natural and beautiful results can be on a friend or relative, you realize plastic surgery doesn’t have to mean fake-looking or severe. Advances in plastic surgery and aesthetics are making procedures less invasive, safe and faster [with] more predictable results,” Majewski says.
The trends also seem to show that millennials — not surprisingly, based on their familiarity with social media and the internet — are one of the largest demographics of patients requesting elective cosmetic procedures. Even with the wave of the Snapchat-famous Dr. Miami and his live-streamed Brazilian butt lifts, most patients really just want to look a little more beautiful. In fact, “selfie awareness” is an actual term being used to describe the phenomenon.
With the wave, a 2018 American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) survey reported that in 2017, more than half of AAFPRS members saw an increase in cosmetic surgery and injectables with patients under 30 and over four-fifths of treatments were non-surgical. Of all patients, 33 percent stated the fear of looking unnatural as their biggest concern.
The increases aren’t necessarily because young people aren’t taking good care of their bodies, however. In fact, it’s actually because they’re more in tune with themselves and more aware of the risks than ever before — read: “sunscreen, sunscreen, sunscreen.” These are what many doctors refer to as “prejuvenation patients.”
“[Millennials] are into preventative treatments; they do the little things,” Michael Devlin, M.D., of Devlin Cosmetic Surgery in Little Rock says. “They’ll even start BOTOX early just to prevent having problems later on, so they are much more into that preventative type of stuff. [They are] much more on top of skin care and skin treatments than the older population is.”
An added layer of prevention on top of just daily skincare products seems to be the bulk of treatments that are being provided in today’s plastic surgery centers. However, as Devlin says, in the end, “gravity always wins.” He still sees many patients in their 70s and 80s for lifting and tightening.
And there are many specialty fields within the world of aesthetic alteration. One comes to mind that is life-changing for the patient.
“We are an [allied health field] and allied health is not physicians; we are specialists,” says Michael D. Kaczkowski, president and director of alloplastics at Real Life Faces Alloplastic Reconstruction. “I work with the physicians and surgeons. When surgical options are no longer available, meaning the technology cannot restore a missing part of the body, the face or scars, or skin missing, all of that stuff where cosmetic surgeons or plastic surgeons have limitations — that’s where I come in.”
At Real Life Faces, Kaczkowski helps individuals dealing with an uncomfortable or unhealthy disfiguration that is beyond a surgeon’s ability to repair — usually around or on their face. Kaczkowski sees patients who are in need of rehabilitation because of a birth defect, a disease, trauma or a number of other reasons. The life-like prosthetic and anaplastology reconstruction help immensely to increase patients’ confidence and self-image. However, correcting facial symmetricality often also has actual health benefits beyond the aesthetic.
“[Alloplastic reconstruction] is highly cosmetic because that’s what I focus on — making it look real, but it’s also restorative because something is missing. So then it also provides anatomical, functional value as well; that’s where it falls into that clinical necessity realm,” says Kaczkowski.
There is a crossover of some procedures. For instance, reconstructing missing eyes is medically necessary because it performs clinical benefits through the socket like diminishing headaches and helping the face as a whole to function more efficiently.
As numerous the options and as wide the world of beauty has become, one thing is certain — as long as aging continues to happen, the technology will continue to stick around, helping patients look younger and more like whatever version of themselves they feel most confident in.
