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Cosmetic surgery gets an injection: growing social acceptance boosts business.

About a month ago, a friend of mine returned from a visit to Indiana, where she caught up with friends, family and a good bit of gossip. The biggest bit: Grandma's were fake. In the 1950s, my friend's grandmother, then a genteel country wife, evidently added some curves to her physique at the dawn of breast implants (I imagine Eva Gabor in "Green Acres.") She told only one of her two daughters, my friend's mom, who finally decided to share the secret with the next generation after Grandma had passed on. That was then, as they say, and this is now. While having elective plastic surgery is still considered taboo to many who see the practice as a misguided attempt to improve one's self-esteem, getting a "procedure" is not as unmentionable as in prior decades. In the past five years, Americans have adopted a new attitude toward having elective surgery. Instead of yesterday's don't-ask-don't-tell policy, today's patients trumpet, "Look what I've got!" The trend is equally vibrant in Utah, where we have more plastic surgeons per capita than most major U.S. cities.

No longer is plastic surgery the domain of women; men, mostly Baby Boomers, are now re-evaluating their love handles, sagging chins and eye bags and opting to go under the knife--or suction tube or needle, depending on the method. Last year men had 1.1 million procedures, a 31 percent increase from 2002. Predictably, women are still the main recipients. According to the American Society of Aesthetic Plastic Surgery (ASAPS), women had 7.2 million procedures in 2003, an increase of 16 percent from 2002. Of those, the surgery most performed was liposuction at 384,626 and in second place, breast augmentation, which was received by 280,401 women. In America, partly due to the increase in breast implants, the average cup size has changed from a B to a C.


Beauty Doesn't Have to Hurt--Too Much

Why are Americans choosing to alter their appearance in such record numbers? Primarily people are attracted by the development of less-invasive procedures that cost less and require less recovery time. The media has also played a significant role in changing public perception of plastic surgery.

Previously, our images of plastic surgery were molded by not-too-kind movie scenes, such as the horrific skin-stretching, cling-wrap treatments in Brazil or the futuristic underground market in Escape from L.A., when Kurt Russell and his female companion are abducted by the surgeon general of Beverly Hills, who wants their fresh body parts for transplants, nips and tucks. Of Russell's friend the surgeon exclaims, "My God, they're real!" Today's TV viewers have ABC's "Extreme Makeover," Fox's "The Swan," the edgy FX creation "Nip/Tuck," Discovery Health Channel's "Plastic Surgery: Before and After" and "Doctor 90210," E! Channel's new reality series about surgeons who work in that notorious zip code. Each program has an overwhelming theme: This can be your life, improved through plastic surgery. Everybody's doing it, why not you?


Get Real About Surgery

Plastic surgery is not for everyone, says Dr. Renato Saltz, MD, creator of Spa Vitoria, Utah's first medical/therapeutic spa for pre- and post-operative treatments. He says the rise in television programming with plastic surgery-based plots is good for his profession, but he worries that some viewers are not grasping the complexities of the procedures.

"They [the TV programs] certainly put plastic surgery into the mainstream. In the 80s, patients were very quiet about having work done, very private. Today, you tell all your friends!" says Saltz, a surgeon for 14 years who specializes in breast cancer reconstruction. "The problem is you always worry about patients with false expectations. This is real surgery with real complications. The impression [given by television] is that it's simple--you get surgery and go home. But surgery is not nothing. These shows are very superficial and people take away reality and create this fantasy."

Dreamland or not, some of today's reality shows provide a fascinating over-the-shoulder view at a surgeon's work--not for weak stomachs--and insight into today's cutting-edge (no pun intended) medical advancements and procedures. While surgical makeovers are no piece of cake, some new products produce good results with much less pain and expense. These less-invasive procedures are opening an entirely new market in the beauty biz.


The New 'Fillers'

"The big news in Vancouver at the ASAPS conference in May [2004] was 'fillers,'" says Dr. Lauren Florence of Salt Lake City, a surgeon at St. Mark's Hospital since 1990. Soft tissue fillers are injectable products that aim to decrease wrinkles and the signs of aging by putting the plump back in your pout and defining the chic in your cheeks. Fat keeps people looking young, but it can break down over time and once gone, bones become more prominent which is why facelifts do not always achieve the desired look; tight skin does not necessarily equal youthful skin. Injectables cushion depleted pockets, such as around the cheekbone, or fill creases and wrinkles. The highly popular Botox[R] and similar botulinum toxin-based products are injectables but they are not fillers; instead they block nerve impulses, temporarily paralyzing muscles and smoothing wrinkles.

The hottest new filler, says Florence, is Restylane[R], made of hyaluronic acid manufactured by recombinant technology. This acid exists naturally in all living organisms and is a component of connective tissues, including skin. Recently approved by the FDA for cosmetic uses, Restylane[R] rarely causes allergic reactions because the acid occurs naturally in humans and results are immediate. In Utah, one treatment, which can last up to eight months, runs about $450.

Fat Can Be Your Friend

Florence, however, is more enthused about another, even more natural product: fat. "I love facial cosmetic surgery and my favorite part is injecting fat," she says. Unlike collagen and almost all other temporary fillers, injected fat doesn't deteriorate. While bovine-derived collagen needs to be reinjected, fat "harvested" from one's own body stays put for years, because the mitochondrial cells actually attach to their new location. Florence says, "It lives. Collagen is dead." Cost is also an advantage; one collagen injection, which must be repeated every few months, costs about $250 in Utah. A new pair of lips built with fat can be as low as $1600 total.


Fat injection or "lipostructure" is not new, but the techniques are just gaining respect. While the American Society of Plastic Surgeons claims results are variable, Florence says that her technique, developed by New York surgeon Sidney Coleman in 1988, works by layering hundreds of tiny threads of fat and has shown results that last for years, with no scarring.


Stimulating Collagen

Another procedure causing a stir is Thermage[R], a non-surgical system for evaporating wrinkles. Radio frequency energy heats the dermis and, according to the company's web site, causes immediate collagen contraction (shrinking equals tightening), followed by new collagen production over time. Treatments take less than an hour, inflict little pain and require virtually no recovery time. Results may not show for weeks, though, and may last only six months. One treatment costs an average of $1400, depending on the area being treated.

No results, from any treatment or by the most highly skilled surgeon, are guaranteed, but they are more assured if a patient seeks a surgeon who has served a plastic surgery residency, is board-certified by the American Society of Plastic Surgeons and works at an accredited facility. Anyone interested in surgery should research a procedure before taking the plunge. Every surgeon has a specialty and particular interests in his or her field, and knowing what you want and what it will take to get it is crucial to success.

At Spa Vitoria in Holladay, education is key. Saltz offers seminars and pre- and post-operative care options that include massages, facials and lymphatic drainage. He says medical spas are not just the newest gimmick of the pamper industry. "We are offering support to the surgical patient. You see results faster, there is less swelling, less pain and it promotes longer-lasting results," he says. "This is not a 'rub and go' spa.'" Since Saltz opened his doors in 2002, at least three other spas have begun promoting similar approaches to the plastic surgery experience.

What it really comes down to is technical expertise and a good doctor-patient relationship, says Dr. Grant A. Fairbanks, a plastic surgeon in Salt Lake City, who adds that most of his patients are people who are unhappy with another doctor's work. "I feel a moral obligation to do the right thing for my patients. I think we need to spend more time listening to our patients in order to best achieve their goals and expectations."

Fairbanks has been in practice since 2003 but he works with a veteran: his father, Grant R. Fairbanks, a plastic surgeon in Utah for 30 years. When asked why he became a plastic surgeon like his father, Fairbanks replies, "Because I'm an artist." But he's not saying this to be cute. His grandfather was Avard T. Fairbanks of Salt Lake City., a nationally-known sculptor responsible for nearly one hundred public monuments. His father, the surgeon, is also artistically talented; he sculpted the eagle atop Salt Lake City's famous Eagle Gate when it was renovated in 1963. (The original was sculpted in 1859 by Ralph Ramsay and William Dell.) And the son, growing up influenced by art and plastic surgery, chose what he sees as the best of both worlds. "This isn't just a job--it's our heritage. While my grandfather sculpted in bronze and wood, my father and I sculpt the flesh," he says. "Surgery is a fine art and plastic surgery is the finest of the fine arts."




Fairbanks emphasizes that in today's world many people see plastic surgery as a viable route to a "sense of normalcy" they don't find in the mirror. Like Dr. Saltz, he is skeptical and even embarrassed by some of the TV programs and the extensive makeover surgeries performed on one person because it's "too much, too fast, and can increase risks." But Fairbanks remains staunch about the integrity of a profession he loves: "The best part about all of this is that people actually feel better. It literally changes people's lives for the better and, for some, their self-esteem is escalated."

Pamela Ostermiller is executive editor of Utah Homes & Gardens and Architecture Utah.

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Title Annotation:Feature
Author:Ostermiller, Pamela
Publication:Utah Business
Geographic Code:1USA
Date:Aug 1, 2004
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