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Plastic surgery is more than just facelifts, and more people are having it done
Tuesday, December 29, 1998 By Ellen Mazo, Post-Gazette Staff Writer
Christine White had had enough of bad skin - the scars from teen-age acne and the fine lines that came with age.
The night her mother died in April was the turning point.
"She looked at me, wanting to know who I was. This was her way of saying, 'You look like hell, girlfriend,' " said White, who lives in Homestead.
At age 47, she decided to have laser resurfacing surgery. Done by an ophthalmologist, it was the cheapest, least invasive way for White to rid herself of those nasty reminders.
"I did this for my mother," White said of the $2,900 procedure.
Martha Dewosky had often joked with her bridge-playing friends about having facelifts. But the 65-year-old widow wasn't amused after seeing a special glamour photo her daughter gave her as a present.
"I looked terrible. All those wrinkles. All those lines," Dewosky said. "I can run. I walk fast. I'm in good shape. I can do anything. I just didn't look like I could do all that."
Dewosky's mother influenced her decision, too. She chose Oct. 9, her late mother's birthday, for her $9,500 facelift. Her plastic surgeon also performed an eye lift and lipoaugmentation, or fat replacement above her cheekbones.
"My mother has been dead for 22 years, but I know she would really go for it," Dewosky said.
Plenty of customers
Lots of people are going for cosmetic surgery procedures.
In 1997, Americans underwent almost 2.1 million surgical and nonsurgical cosmetic procedures, according to the American Society for Aesthetic Plastic Surgery, an educational and lobbying association.
That includes everything from breast augmentation to liposuction to tummy tucks to complete facelifts to hair transplants to laser skin resurfacing to nose reshaping to collagen injections.
There are no separate statistics for Western Pennsylvania, but regional numbers coupled with anecdotal information from surgeons show that the upward trend has hit home.
"People in Los Angeles talk about it and flaunt it. People in Florida talk about it, but don't flaunt it. People here don't talk about and don't flaunt it," said plastic surgeon Dr. Leo McCafferty.
McCafferty, who is on the staff at Mercy Hospital and several other hospitals, was practicing in Miami when he realized that more than a few of his patients came from Pittsburgh. He decided his practice could flourish here.
"I was told that Pittsburgh was the place to be," says Dr. Raymond Capone, who came here to train in surgery 20 years ago after graduating at the top of his class at Georgetown University Medical School.
Doctors interviewed say Pittsburgh is well-stocked with good plastic surgeons, a holdover from the days when Dr. Milton Dupurtius of the University of Pittsburgh trained some of the biggest names in the field: Ross Musgrave, Dwight Hanna, William Garrett, William White.
The region's large older population provides plenty of interested patients.
Aging baby boomers - from 35 to 50 -had 46 percent of all the cosmetic procedures performed in 1997, national statistics show. Twenty-four percent were done on 19- to 34-year-olds, and 22 percent of the procedures were on 51- to 64-year-olds.
Most patients are Caucasian, with 4 percent African Americans, 4 percent Asian descent and 6 percent Hispanic. More than half are women.
"You eat the right food. You try to avoid sun exposure. You work out. You do everything to maintain internal health," said plastic surgeon Dr. Lori Cherup, who practices in Bethel Park. "It's a way to maintain and rejuvenate your body."
But competition has become so intense, and the procedures so lucrative, that more doctors without specific surgical training are getting into the aesthetic surgery business.
As Allegheny General Hospital plastic surgeon Dr. Bernard Cohen pointed out, doctors advertise that they are "board certified" without explaining that the board may not be recognized by the American Board of Medical Specialties.
No matter who a person chooses, there are risks associated with elective surgery - and the numbers are climbing.
While there are no organizations that track complications with plastic surgery, Dr. Robert Goldwyn, a Harvard medical professor who has written a text on plastic surgery complications, says 5 to 10 percent of the patients may experience excessive bleeding, scarring, wounds that don't heal well or other forms of dissatisfaction.
And some patients have died.
An old phenomenon
What is this plastic surgery phenomenon?
Author Elizabeth Haiken points out in her book, "Venus Envy: A History of Cosmetic Surgery," (The Johns Hopkins University Press), that the first cosmetic nose job was in 600 B.C.
Aesthetic plastic surgery comes from the Greek word "plastikos" - to mold or give form.
While the recent proliferation of aesthetic surgery procedures seems tied to the rise in the number of baby boomers obsessed with staying young, Haiken writes that the trend is at least a century old and a result of our increasingly urban society.
"Plastic surgery is age-dependent," said plastic surgeon Dr. William Swartz, who practices at UPMC Shadyside. "The baby boomers are coming into the time of their life that their facial features are sagging. More and more are coming in for eye lifts, for facelifts."
As a result, plastic surgeons are expanding their practices to include full-service skin care products that can be found only in the doctors' offices, even though they can be purchased without a prescription.
"Plastic surgeons are involved because that's what their patients want," said Swartz. "They provide counseling on good, healthy skin care. We can't stop the aging process, but many patients are happy to work with a less aggressive approach than surgery to approach their aging."
As part of that, Dr. Dennis Hurwitz, director of the Aesthetic Plastic Surgery Center at UPMC Health System, said that plans are under way to open a center at Magee-Womens Hospital late next year staffed by plastic and oral surgeons, dermatologists, ophthalomologists and other specialists to provide cosmetic surgery, skin care, cosmetic dentistry, massage, micropigmentation (medical tattoos), nutrition and fitness counseling.
"There's an increased interest in cosmetic surgery, and we want to be able to deliver the services," said Hurwitz, who is president-elect of the Allegheny County Medical Society.
Feeding a demand
The demand for aesthetic care clearly is here.
Nationally and locally, liposuction has become the plastic surgery of choice.
Swartz believes that the popularity has a lot to do with public awareness, particularly through advertising campaigns that play on customers' desires for a quick way to get rid of unwanted fat.
But breast augmentation, breast lifts, nose surgery and tummy tucks are also popular. Some people are having collagen (a protein substance made of bone and tissue) added to their lips, for a fuller, more youthful look. Others are clearing their skin without surgery - with chemical peels that strip away the skin's top layers.
Some are undergoing injections of a toxic substance, Botulinum toxin type A - or Botox.
If ingested, the toxin can be fatal. However, patients find that their frown lines, crow's feet and furrowed brows disappear overnight once they are injected with the substance that temporarily paralyzes facial muscles that create the worry lines. The effect lasts four to five months, and the procedure costs about $500 per injection.
It is in the past 26 years - pinpointed from the time that doctors began advertising - that plastic surgery has become the fastest-growing medical specialty.
"The single biggest change is public awareness, and the second is the improved technology and procedures," said McCafferty, spokesman for the American Society for Aesthetic Plastic Surgery. "We're more patient-friendly, and there is less guilt about having these procedures done."
Because the purely cosmetic procedures are not covered by insurance, doctors can control how they levy fees. Some doctors have set up installment payment plans, allowing patients to pay for cosmetic surgery the same way they buy a car.
Moreover, as technology improves, so do the procedures. What at one time required weeks for recovery now may only need days. Surgeons are using endoscopic surgery, which allows them to insert their instruments into small holes. There are fewer surgical scars that need to heal.
Growing practices
Ophthalmologist Dr. Roxana Barad is an example of a doctor who has expanded her practice to include laser skin resurfacing.
Barad, who got specialty training in eye surgery at Harvard University Medical School and is associated with St. Francis Medical Center, has opened the Aesthetic Laser Center as part of her Pittsburgh Eye Associates.
She performed the laser resurfacing procedure on Christine White the day before Thanksgiving.
Barad found that as an eye surgeon trained with lasers she was qualified to expand her services.
"The eyes are the most delicate tissue to deal with," Barad said. "If you understand the eyelid, you can get a natural result."
She promotes laser resurfacing because it is not an invasive facelift.
"There's quick recovery with dramatic results," Barad said. "In ophthalmology, we've been using lasers since the early 1980s. I have a passion for the laser, for its technique, for what it can deliver. During my residency, they called me the 'Laser Queen.' "
White, who had gone to Barad for eye care, said she became entranced with the idea of having smooth skin.
She also liked the idea that she would miss few, if any, days of work.
She had her laser resurfacing surgery in Barad's Penn Avenue office and returned to her job as a computer specialist with a telecommunications company in the middle of the following week.
White took sedatives several hours before the surgery, and was given a strong intravenous anesthetic during the procedure. She listened to John Tesh tapes on a Sony Walkman, so she did not hear the loud, dental drilling sound of the laser machine and vacuum that sucked up the dead skin that Barad had burned off her face with the laser.
Wearing goggles, Barad methodically moved the laser beam up and down White's face, around her lips, on her nose and around her eyes.
"I'm concentrating on the wrinkles and the big pores," she said.
Nurses sopped up the blood with cold pads.
Several hours later, White went home to a weekend of "a weird feeling. I just wanted to sleep. It was like my skin was drying off. It cracked. It pinched.
"The first day, I was ugly. When I looked at myself in the mirror, I didn't believe it. I thought I had iodine all over my face."
White must be particularly careful about exposing her baby-new skin to sunlight to avoid pigmentation and pain from the ultraviolet rays. She now wears sun block every day, and tries to protect her face with a brimmed hat. She will need to take these precautions from now on, Barad said.
White insists she would go through the procedure again because of the results. Her skin is now silky smooth.
"It's amazing," she said.
Martha Dewosky, who lives in Murrysville, is just as delighted with the results of her surgery, performed by Hurwitz of UPMC.
While she is older than most of Hurwitz's patients, he found her to be a good candidate: She is healthy, active and was concerned that her appearance belies her active lifestyle.
Now, two months later, Dewosky also says she would do it again - even with some of the post-surgical complications, including a blood clot in her neck that was easily treated, Hurwitz said.
Dewosky demurred about how she looks.
"Everyone says I look great, so I guess I do," she said. "I waited a month to go out, and I'm still a little swollen. But it doesn't hurt."
Now, she said, "Every person I look at, I see their wrinkles."
Hurwitz said that Dewosky's surgery was a traditional facelift incorporating new techniques.
He began the six-hour operation at Montefiore Hospital making incisions along the border of her scalp and around her ears to pull back the skin. However, rather than just tighten the skin, Hurwitz also made an incision above the gum line, loosening the sagging cheeks to make room for fat injections.
He then performed a small liposuction in her belly to extract fat to inject in small parcels at various points in her cheeks.
"A major factor of the aging face is atrophy," Hurwitz said. "As you get older, you look more drawn."
The fat injection procedure is probably the newest among facelift techniques, and is still being refined. About 5 percent of the patients need to return for corrections from irregularities.
No matter what the drawbacks, more and more people looking for ways to stay forever young are seeking out aesthetic plastic surgery.
Cherup, the Bethel Park doctor, refers to her plastic surgery colleagues as the "family doctors of the body."
"Plastic surgeons are surgeons at heart, but more artistic. I like the aesthetic part. I have an idea of what you want to be, and I help make you the way you want to be," she said.
Ellen Mazo's e-mail address is: emazo@post-gazette.com.
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