Table of Contents
- I'm interested in cosmetic surgery. What should I do now?
- Should I get a second opinion, and several price quotes?
- How do I find a cosmetic surgeon who is right for me?
- Where do I find truthful, useful cosmetic surgery information?
- I know want I want to change, but I don't know what to do next?
- I want cosmetic surgery, but I'm afraid, I hear so many horror stories.
- Magazines and TV say to expect $10,000 to $20,000 for cosmetic surgery. Is that really true?
- How long will the results of cosmetic surgery last?
- I want a facelift, but I can't afford $15,000. Do I have other options?
- Is any laser hair removal permanent? I have my doubts.
- How could I possibly be awake for liposuction or a facelift? That sounds crazy.
- I'm afraid that "minimal incision" and "local anesthesia" procedures won't give me enough of a change. I can't help thinking that I won't get the change that I want without some suffering and more time off.
1. I'm interested in cosmetic surgery. What should I do now?
The first step is to decide exactly what it is about yourself and your body (or appearance) that you would like to improve or change. Be as specific as possible. (If you know where you would like to go, it is much easier to get there.) Then research the different options available to change or improve that area. The Internet, the library, magazine articles, and literature from surgical organizations and surgeons are good starting points. When you have decided what you want to change and done some homework, find a cosmetic surgeon in your area and schedule a consultation. You may benefit from at least two such consultations and price quotes. Research any surgeon whom you are seriously considering. You may want at begin at the websites.
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2. Should I get a second opinion and several price quotes?
Get at least two opinions, more if you cannot find a surgeon with whom you are comfortable and who will answer your questions frankly. Get at least two price quotes, with complete breakdowns of all prices. Always ask about the different types of anesthesia available, and the facility fee. If the opinions and/or quotes vary widely, continue to research.
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3. How do I find a cosmetic surgeon who is right for me?
Use the phone book, professional societies, friends, other doctors. Meet him/her and spend some time in the office, with staff and surgeon. Ask to speak to several of their patients who have had the same surgery you are contemplating. By all means, if it doesn't feel right, go elsewhere. The surgeon should plan the surgery and the anesthesia for your convenience and desires, not his own, with safety being paramount. For your part, you should be very clear and focused regarding the changes and/or improvements you desire, and how much change you want. If your goals are unrealistic, a smart surgeon will either educate you until you become more realistic, or suggest that you choose another surgeon. I dislike surgeons who routinely suggest additional procedures when approached by patients with very specific requests.
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4. Where do I find truthful, useful cosmetic surgery information?
See the sections of this website titled Before Your Cosmetic Surgery: Facts You Should Know and Web Sites of Interest. See also above. Truthful and useful are the key words. If it sounds way too good to be true, it probably is. Promises of anything more than 50-75% improvement may be suspect. Try to access cosmetic surgery information from Europe and South America. They are often several years ahead of North America. The potential "downside" to their techniques is a much less conservative approach to new procedures. Surgeons who say they've had no complications are lying or delusional. Books by non-surgeons (often patients) can be very helpful. The American Academy of Cosmetic Surgery is objective and helpful. A book about laser treatments, Beauty and the Beam, is very good.
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5. I know what I want to change, but I don't know what to do next.
You are halfway there if you know exactly what you want. Hopefully, there is a realistic, safe method to get it, whether surgical or not. If your concern is the texture of your facial skin and fine lines and wrinkles, no amount of face-lifting will help. That would be like reconditioning a sofa with the same old material. What you fundamentally needed was new material, not new framing. Conversely, no amount of skin change will improve sagging muscles. You get the idea.
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6. I want cosmetic surgery, but I'm afraid, I hear so many horror stories.
You must be proactive in specifying your wants, needs, and preferences. Most horror stories are caused by a combination of general anesthesia, poor judgment, excessive surgery, and ignorance. Are you willing to accept 70% improvement using a very safe procedure, rather than "trying for" an 80% improvement with a procedure and/or environment that is, statistically, 5,000-10,000 times more dangerous? Are you willing to experience some mild discomfort during the surgery (rather than being asleep) to be 2,000-10,000 times safer, assuming that both procedures result in similar improvement? These are not exaggerations, although most surgeons do not discuss things this way. Amazingly, the safer procedures are almost always less expensive.
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7. Magazines and TV shows say to expect $10,000 to $20,000 for cosmetic surgery. Is that really true?
Multiple factors influence the cost. You are entitled to a complete "breakdown" of the charges, and should always ask for one. The country, area of the country, the type of procedure, the number of concurrent procedures done, the facility fee, the surgical fee, the anesthesia fee, lab tests, pictures, garments, and travel can all increase what initially seems to be a very reasonable surgical fee. In cosmetic surgery, just because it costs more does not mean that it is better. If a very low price is the goal, there is a clinic in India (on the Web) which charges about $300 USD for breast augmentation. Of course, you have to get there, but they market travel packages. Get several price quotes. A few surgeons actually list their charges, but that is uncommon. Traveling out of state to have lower priced surgery may make sense, if you know and trust the surgeon, a large amount is involved, and you can stay away long enough to be examined after surgery. We know reputable surgeons whose facelift charges range anywhere from $5,000 to $20,000, (for the same surgery) depending upon the surgeon, the area, and what the market will bear. Even greater discrepancies are present in some liposuction charges. The single greatest factor in keeping the cost down is to focus solely on why you originally came to the consult. Many, many plastic surgeons derive at least 40% of their income from "add on" procedures, things suggested to the patient when they come in for another concern. The old "What the heck, I'm asleep anyway, might as well do it all at once." The minute a patient says that, the risks rise even faster than the costs. Anesthesia is more involved, surgical time is longer, insult to the body is greater, recovery time is longer, etc. A common result of this is that the patient has a very difficult, prolonged recovery period, and vows never to have cosmetic surgery again. A cynic might say that the surgeon encourages "clients" to have everything done at once because he/she knows that patients will never return for a second surgery. Nothing is inherently wrong with that, but that statement and attitude have profound consequences for you as a patient, both economic and physical.
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8. How long will the results of cosmetic surgery last?
Well, it depends on many things. Will you not smoke, avoid direct sun exposure, eat well, exercise, maintain your general health, and limit alcohol use? If so, then count on 6-10 years minimum. Unlike the picture of Dorian Gray, you will not awaken one morning 6-10 years later with the results completely gone. Change is gradual, and in 6-10 years, you are 6-10 years "ahead" of those who did not have cosmetic surgery, or that much better than you might have been without the surgery. Warren Beatty is said to have not smiled (in private) for at least 20 years, in an attempt to avoid creases in his face. If you could sleep upside down, bat like, gravity would have minimal effects on your face. Most of us are not quite that committed, or would be committed if we tried that sort of excess. The fat cells removed with liposuction are gone forever, but if you continue to gain weight, the remaining cells will expand, and be noticeable.
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9. I want a facelift, but I can't afford $10,000. Do I have other options?
Yes. You can find a less expensive surgeon (assuming a comparable skill level). You can find a less expensive procedure (assuming that it meets your criteria for results). Both are usually possible. First, decide what it is that you really want to change. If it is the neck and jaw line, several very effective, much less expensive procedures are available. Liposuction of the lower face with neck tightening can produce excellent results for at least 60% less. Minimal incision facelifts are available for much less (50% or more), but you will need to search for them. If the skin is your concern, ask about laser resurfacing or facial peels as alternatives. A blepharoplasty (removal of excess eyelid skin) can often provide a definite lift to the upper face. Rigorous daily skin care combined with mild to moderate facial chemical peels can often give nice results. Remember, you can have the rejuvenation in stages, with less recovery time and less expense. Find a surgeon who will explain these options and work with you. Like many professionals who do piece work, some surgeons quote very high prices. If they charge twice as much as others, and get the 50% of the patients to agree half of the time, they will make just as much money as someone doing twice the surgery, yet charging half as much. This is not an unusual scenario.
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10. Is any laser hair removal permanent? I have my doubts.
First, what does permanent mean? The first hair removal laser (EpiLaser by Palomar, which Trillium first used in 1997) has been updated many times by Palomar. We now use Starlux IPL, the most advanced, powerful hair removal system available. Most patients have had no "re-growth" of hair in treated areas for 8 years. Will they ever have re-growth, in their entire lives? I doubt it, but no one can give you any longer experience than 8 years. Beginning in 1997, Trillium has treated over 1,000 patients, with over 5,000 treatments. Over 98% of those patients have had at least 90% hair reduction (consistently) after 7-12 treatments, and many for over 8 years. We consider that successful, permanent treatment. Many lasers and IPL machines are now "approved" by the FDA to market permanent "reduction" of hair follicles. Most of them are not very effective, which the FDA has completely ignored. We believe that Palomar's Starlux IPL is the current "gold standard" in hair removal systems. There is no question that IPL hair removal (with the right IPL and a skilled operator) is the safest, longest lasting, most cost effective, most comfortable method of hair removal now available. Proponents of electrolysis (and its operators) disagree, but most of our patients will tell you that they would never have electrolysis again after having IPL hair removal. In fact, IPL hair removal is actually less expensive than electrolysis, after all needed treatments.
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11. How could I possibly be awake for liposuction or a facelift? That sounds crazy.
Not at all crazy. Most patients say that these awake surgeries are easier than "having a tooth filled at the dentist." Tumescent anesthesia is 2,000-10,000 times safer than other methods, just as effective, and the results are at least as good. Recovery time is usually much, much less. After liposuction, most patients return to work in 48 hours. After a minimal incision facelift, most patients return to work in 3-5 days.
Tumescent anesthesia is given through areas that are first numbed with a very tiny needle, the size used in allergy testing. A dilute solution is then placed beneath the skin, a process which often takes 45-60 minutes for liposuction, 15 minutes for a facelift. The solution is then allowed to "diffuse" for 30 minutes before any surgery is begun, allowing widespread, deep numbing. (This is the step which is ignored by many physicians, since it requires 30 minutes of "downtime.") Some patients will talk, some will sleep while the procedure is done. More solution can be given at any time if you become uncomfortable. The most important advantage is that the anesthesia is not given in your veins, and does not affect your whole body. Patient acceptance is superb, comfort during surgery is usually excellent, and the recovery is many times easier than after being "put to sleep."
Frankly, many surgeons, anesthesiologists, and hospitals prefer to ignore tumescent anesthesia. Plastic surgeons ignore it because they can only do 1/3 the number of cases in the same amount of time, many do not enjoy awake patients, and most have never been trained to use it. Anesthesiologists ignore it because it renders them unnecessary. Ambulatory surgical centers and hospitals ignore it because their charges for the surgical rooms are curtailed. First reported in 1987 by the dermatologist, tumescent anesthesia is not yet mentioned in any textbooks of anesthesia of which we are aware, 19 years later. Many anesthesiologists have either never heard of it, or simply do not understand it.
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12. I'm afraid that "minimal incision" and "local anesthesia" procedures won't give me enough of a change. I can't help thinking that I won't get the change that I want without some suffering and more time off.
The method of anesthesia and numbing have nothing to so with the amount and quality of the surgery done. They simply allow the patient to be comfortable while the procedure is done. Surgical techniques "evolve" and improve. Just as cataract surgery used to require a large incision with many sutures, and sandbags to the head for two weeks (as late as 1979), cosmetic surgery has changed. Very effective, pleasing cosmetic results do not require suffering. Many of the more traditional facelift techniques have not changed for 35 years. Liposuction techniques, invented by a French obstetrician around 1970, changed very slowly until 1987, when tumescent anesthesia was invented. Nineteen years later, most plastic surgery programs do not teach true tumescent anesthesia. In fact, the plastic surgeons in California continue to attempt to deny hospital tumescent liposuction privileges to the very dermatologist who invented it, contending that he is unqualified to perform the surgery which he invented, and taught all of them. (He is 57 years old, very active, and very healthy) Go figure. Clearly, patient comfort and well being is not paramount in these issues. Often, "less is more." Safe and comfortable surgery, a rapid and comfortable recovery, and an excellent result are obtainable goals, without suffering or pain. For instance, one of the myths about laser facial resurfacing is that "the longer the face is red, the better the result." This is nonsense, but it is nonsense spread by some surgeons who use very hot lasers and create months of redness. I have even attended a liposuction conference where a surgeon who does not perform true tumescent liposuction ridiculed this procedure, implying that there is something wrong with the patient being safe, awake, and comfortable. Wrong for whom? When that same surgeon's wife has liposuction, guess what? If he loves her, he'll want her to have true tumescent liposuction. Remember, it's not the surgeon who suffers from an outdated, less safe, less comfortable surgical method. You do. Last time we checked, the patient is paying the surgeon for a service. What patient would go to a surgeon and say, "You know what, I don't want the newest, most effective techniques, I'd like some good old fashioned 'retro surgery,' complete with more pain and suffering."
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