On Plastic Surgery in 2012, An Exercise in Forecasting

On Plastic Surgery in 2012: Raw Sources
Elizabeth Franko

Telephone Interview with Dr. Bryan Forley: 2/16/01

thoughts developments in plastic surgery in the next 10 years.
1. minimal scars- fewer incisions- endoscopy- fasterhealing time

2. stem cells: using a person's own cells: grown own
cartilage, fat: in petri dish, reconstructioncollagen: face, lips, nose
bone and skin grafts

3. improved materials for breast implants- soft,
tolerable, natural tissues, no capsular contraction

4. better lasers: facial rejuvenation, no down-time,
minimize healing process: developing lasers that only
affect the deep layer and not surface layers of skin-no down time at all

5. baby boomers are concerned about appearance- it is a part of their lifestyle
as baby boomers get into their 60's, increase in face,eyes, skin procedures

6. every year it becomes more socially acceptable to
get surgery...especially for the younger generation,
seeing their baby boomer parents and grandparents
getting procedures done- this reinforces the feeling
that it is ok- not like 20 years ago- not to be kept behind closed doors

Wired: p.126
"Cloning technology is already being integrated into important medical
research. The ability to grow totipotent stem cells- the embryonic building blocks
from which all the body's cells develop- is sparking a revolution. By using nuclear
transfer- the essential procedure in cloning- scientists may soon be able to create
transplantable tissues from stem cells to generate tissues that perfectly match a
patient's.

Channel 4 News at 5: 2/22/01
A Report on "Tissue Glue": A glue placed under skin
lifted during plastic surgery
procedures. This stop bleeding and prevents bruising, leading to all-around faster
recovery times.
One New York Plastic Surgeon, Dr. Shewood Baxt, is using this glue to offer patients a
"weekend facelift", with recovery times shortened to 2-3 days as opposed to 2-3 weeks.

Information from The American Society of Plastic and Reconstructive Surgeons

The number of people who had cosmetic surgery procedures in 1999 nearly tripled those
who had them performed in 1992, according to a new report by the American Society of
Plastic Surgeons (ASPS). The five most popular procedures in 1999 were liposuction,
breast augmentation, eyelid surgery, facelifts and tummy tucks.
"Cosmetic surgery is more popular than ever," explains ASPS President C. Lin Puckett,
MD. "Both women and men are choosing cosmetic procedures to keep their youthful
appearance and feel good about themselves. Also, the technical advancements made in
plastic surgery over the last few years have made cosmetic procedures easier and safer
for the patient."
"We anticipate that these numbers will continue to grow well into the millennium," says
Dr. Puckett. "Not only are more and more people concerned about looking their best, but
new techniques in cosmetic surgery will give patients more options and improved
results."

Information from The American Society of Aesthetic Plastic Surgeons

COSMETIC SURGERY PREDICTIONS FOR 2001

From the American Society for Aesthetic Plastic Surgery (ASAPS)
NEW YORK, NY (December 29, 2000)

Anti-aging will be the buzzword of the decade. Anti-aging includes everything from
plastic surgery to chemical interventions, hormone replacement and vitamin therapy,
nutrition, and mind/body medicine--all aimed at prolonging youth, health and vitality.
Plastic surgeons and endocrinologists will become the leaders in this new integrated
field.
"Nips and tucks" will be preferred over major cosmetic surgery "overhauls" by aging baby
boomers. Minimally invasive procedures that require little or no down time will be
sought after by the growing baby boomer population to decrease the early signs of aging
and postpone major surgery a little longer.
Procedures such as facelifts and skin resurfacing will become less invasive and recovery
will be faster. More patients will request short-scar facelift techniques and skin
resurfacing treatments using newer types of lasers or radio frequency electrosurgical
devices that reduce tissue trauma and recovery time.
Advances in tissue adhesives will have a growing impact on cosmetic surgery. The use of
tissue glue in face and brow lifts will be adopted by an increasing number of plastic
surgeons as its potential benefits of more rapid and predictable healing are further
substantiated.
New drug delivery modalities using sonic waves will increase the effectiveness of skin
care treatments. New skin care product formulations used in conjunction with ultrasound
will allow for deeper penetration of topically applied rejuvenating agents into the
skin, resulting in significantly improved aesthetic results.
Cosmetic plastic surgery will be more accessible. However, the overall quality of care
will decline as more practitioners without formal plastic surgery training assume the
mantle of "cosmetic surgeon." Price competition between those vying for cosmetic surgery
clientele will appear to offer patients more choices, making credential checking and
surgical facility accreditation ever more important.
"Added value" cosmetic surgery will become popular among those who can afford to spend
more. "Added value" might include post surgical pampering in a spa-like setting close to
the patient's home or counseling in holistic health, diet and exercise.

"EXCESSIVE" COSMETIC PLASTIC SURGERY: HOW MUCH IS TOO MUCH?

New York, NY (January 15, 2001)
Undergoing multiple cosmetic procedures, simultaneously or over a period of time, is not
unusual. People today live longer and, increasingly, seek to achieve and maintain an
appearance that matches their self-image at every stage of life. Yet there is a very
small subset of people who, if given the opportunity, may elect to undergo an excessive
number of procedures without ever feeling satisfied with the outcome.

Appropriateness of Multiple Procedures
How much cosmetic surgery is too much? The answer depends on the reasons it is chosen,
when it is chosen, and the patient’s expectations. A patient who has a strong personal
desire for self-improvement and is able to identify specific, realistic goals for
surgery is likely to be a suitable candidate for one or more procedures.
Multiple procedures performed at the same time may be appropriate, with proper safety
considerations, in order to create or maintain harmony among physical features. For
example, a facelift is often combined with eyelid surgery and a brow lift to achieve
harmony among the various "aesthetic units" of the face. Following surgery, all parts of
the face may then continue the aging process at a more similar rate.
Over an individual’s lifetime, there may be various stages at which cosmetic surgical or
nonsurgical enhancements can improve the quality of life. Procedures may be spaced at
intervals of a few years, a decade or more depending on the individual’s goals. The
following might be a typical sequence of procedures:
30s:Botox injections to address fine wrinkling around the eyes
Tummy-tuck and breast lift after childbirth and breast-feeding are completed
40s: Lipoplasty (liposuction) for double chin and fat deposits in hips and thighs
Vein injections to eliminate spider veins
50s: Facelift, eyelid surgery
Patient Evaluation for Surgery
One clue as to whether a patient is seeking "excessive" surgery is the source and degree
of motivation. An individual seeking cosmetic surgery should always be self-motivated;
having surgery to please family members, a significant other or spouse is never
appropriate. In addition, strongly motivated patients have been found to experience less
pain, recuperate faster, and have a significantly higher index of satisfaction.
Individuals with low self-esteem who obsessively focus on minor flaws or believe that
surgery will work a miracle in their lives are bound to be disappointed and
dissatisfied. Such persons are not appropriate candidates for cosmetic surgery. In
extreme cases, individuals exhibiting these traits may suffer from Body Dysmorphic
Disorder (BBD), a rare psychiatric condition characterized by an uncontrollable
preoccupation with an imagined or slight defect in appearance. Responsible surgeons try
to identify inappropriate patients during their preoperative evaluations, and do not
recommend surgery for such individuals.
COSMETIC SURGERY TIMELINE:
Individuals age uniquely and at different rates depending on heredity, lifestyle, sun
exposure and other factors. The American Society for Aesthetic Plastic Surgery (ASAPS)
provides the following chart as a "typical" timeline for the enhancement and
rejuvenation of appearance through cosmetic surgical and nonsurgical procedures:
IDENTIFIED DISSATISFACTION: COSMETIC PROCEDURE
MID 20s to MID 30s:
Early frown lines between brows: Botox injections
Small or asymmetrical breasts: Implants
Localized fat deposits: Lipoplasty
MID 30s to MID 40s:
Gradual hooding of upper eyelids: Upper eyelid surgery or brow lift
Puffiness under eyes: Lower eyelid surgery
Fine wrinkling around eyes: Skin resurfacing and/or Botox
Frown lines between brows: Botox or endoscopic forehead surgery
Fine wrinkling around lips: Skin resurfacing/chemical peel
Nasolabial folds or creases: Collagen
Fat deposits in hips, thighs, abdomen: Lipoplasty
Muscle weakness/loose abdominal skin: Mini or full tummy tuck
Loss of volume/tone in breasts: Breast lift with or without implants
Spider veins: Sclerotherapy (vein injections)
MID 40s to MID 50s:
Sagging eyebrows: Brow lift
Double chin: Lipoplasty
Vertical cordlike structures in neck: Neck lift/tightening procedure
Descent of cheek fat: Mid-facelift
Development of jowls: Lower-facelift
Slight drooping of nasal tip: Rhinoplasty
Thinning of lips: Lip augmentation
Pattern baldness: Hair restoration
60s and BEYOND:
Facial wrinkles and creases: Skin resurfacing/chemical peel/Botox/collagen/fat injections
Recurring facial laxity: Repeat facelift
Excess fat and skin in upper arm: Upper arm lift

Post Human: By Jeffery Dietch
Social and scientific trends are converging to shape a new conception
of the self, a new construction of what it means to be a human being.
The matter-of-fact acceptance of one's "natural looks and one's "natural"
personality is being replaced by a growing sense that it is normal to reinvent
oneself...There is a new sense that one can simply construct the new self that
one wants, freed from the constraints of one's past and one's inherited
genetic code.
Human evolution may be entering a new phase that Charles Darwin never would have
envisioned. The potential of genetic reconstitution may be quickly propelling us
beyond Darwinian natural evolution and into a bold realm of artificial evolution...
Our children's generation could very well be the last generation of "pure" humans.

Sexual Issues for Aging Adults
Introduction

The marked increase in life expectancy over the past century has meant that individuals over the age of 65 years form an increasingly large
proportion of our population. Yet, very little attention has been paid until recently to the treatment of sexual dysfunction in older adults (Spence,
1992).

Aging adults are the fastest growing segment of the U.S. population and it is estimated that by the year 2000 that 20% of all people in the United
States will be 65 or older (Comfort, 1976). With this in mind, it is unfortunate that relatively little attention has been focused on their sexual problems
and concerns, and what little information is available doesn’t seem to be easily accessible.

Mary Tudor, producer of Suzi’s Loveseat, one of only a few Internet resources on sexuality and the aging says, "there isn’t much on the Web about
sexuality and aging. Likewise, when I visit the bookstore, I find little specifically on that topic"(Personal Correspondence, 1998).

"Nip, Tuck, Click: Plastic Surgery on the Net is Hip"

By NANCY HASS
Dianne Gold and Haley Strom, college sophomores who room together in
the East Village in Manhattan, had a lot to catch up on this past week
after a summer back home in suburbia.
First there was the face lift. Not theirs, but the one they both
watched in August from their homes, live on the Internet. "I loved that one,"
said Ms. Gold, who grew up outside Miami. As she spoke, she unpacked
what looked like a semester's supply of rice cakes from her Teletubby
backpack. "They folded the skin right up over his head like Spandex."
"Totally," replied Ms. Strom, who considers herself "a cosmetic surgery
native," having grown up in the San Fernando Valley outside Los
Angeles, where plastic surgery is practically a way of life in some circles.
"But did you catch the liposuction? It rocked."
She rushed over to her sleek new laptop to log on to onlinesurgery.com,
one of several Internet sites that run live Webcasts of cosmetic
surgery procedures. Her screen lighted up with archived video footage of the
liposuction.
A doctor's hand slid a slim tube into a fresh incision and wobbled it
around until it hit a pocket of pale yellow globules, sucking them up
like a McDonald's shake through a straw.
"I jacked up the audio and then programmed it right into my start-up
preferences," Ms. Strom said. "So whenever I boot up, you get this slurp
of all the fat going through the tube. It's fantastically disgusting."
It's not surprising that these students talk about Webcast liposuction
as if it were the latest gross-out teen-age horror flick, now that
plastic surgery has gone from medical procedure to pop cultural event. In
recent years, as more people have elective procedures, what was once a
private, or even shameful, act of vanity, has gone public.
People not only talk openly about "having work done," but also publish
their own adventures under the knife in book-length memoirs and in
magazines like Vogue, Mirabella and Harper's Bazaar, often accompanied by
"before," "during" and "after" photographs. On network television and
cable channels, there are day-by-day diaries of plastic surgery and
graphic reports of new procedures from the operating room.
Even on "The Operation," a serious-minded unedited show that has run on
the Learning Channel weekly since 1995, the highest-rated show last
year was the only one that featured a voluntary cosmetic procedure, a
breast reduction.
"I like to think it was well watched because a breast reduction is more
unusual than a breast augmentation and therefore more scientifically
interesting, but maybe I'm just naive," said John Ford, an executive at
Discovery Communications Inc. who created the show while he was at the
Learning Channel.
And now on the Internet, unexpurgated Webcasts of operations like brow
lifts and stomach stapling are drawing viewers, ranging from people who
are interested in having surgery to teen-agers who watch it for the gory thrill.
"The change in the degree to which people want to explore plastic
surgery publicly, both their own and others, is staggering," said Sander
Gilman, a University of Chicago professor of Germanic studies who this
year published two books on plastic surgery: "Creating Beauty to Cure the
Soul" (Duke University Press) and "Making the Body Beautiful: A
Cultural History of Aesthetic Surgery" (Princeton University Press). "It's
become something to be declared, a fascination to be shared."
The cultural shift seems to have taken place in the blink of an eye
lift. When Geraldo Rivera had fat removed from his buttocks and reinjected
between his eyebrows on television in 1992, he was lambasted as a
self-exploiting egomaniac.
As recently as early 1997, Helen Bransford, a writer, met with
controversy after she published her own public paean to plastic surgery,
"Welcome to Your Facelift" (Doubleday), a chatty story of how surgery saved
her marriage to the writer Jay McInerny. "I took a lot of grief, and I
won't say it wasn't justified," she said recently.
When Joan Kron wrote a first-person account for Allure about shopping
for a plastic surgeon in the early 1990s, she kept her byline anonymous.
But by the time she published "Lift: Wanting, Fearing -- and Having a
Facelift" (Viking, 1998), she used not only her own name but also the
intimate details of her experience. "I thought I would be treated like a
pariah, that people would scream 'vanity, vanity, vanity,"' she said,
"but everyone was really supportive."
It's not hard to understand that Ms. Kron would receive such a warm
embrace, considering how many people there now are who can relate. Last
year alone, almost three million people in the United States underwent
such elective procedures, according to the American Society for Aesthetic
Plastic Surgery.
In the last decade, nearly 10 million American adults have had cosmetic
surgery, more than 6 percent of the country's total adult population.
And more than 65 percent of those people had household incomes below $60,000.
The nipped and tucked, now well represented in every social strata,
have coalesced into a community. Like the recovery movement, its members
have their own language of openness and a roster of celebrity role
models -- Dolly Parton, Roseanne, Joan Rivers, Carol Burnett, Mary Tyler Moore.
The new community of surgical transformation has found its ideal
vehicle in the Internet. Immediate, graphic and unencumbered by standards of
taste, cyberspace has proved to be the place where three of modern
culture's most irresistible urges have collided: fascination with
technology, obsession with celebrity and desire to peek behind the scenes.
Earlier this year, the comedian John Byner had a four-and-a-half-hour
face lift on celebritydoctor.com., and more than 50,000 people tuned in
last month when Carnie Wilson, the singer and a daughter of Brian
Wilson of the Beach Boys, had a gastrointestinal bypass, a voluntary
procedure used as a last resort in weight loss, on adoctorinyourhouse.com.
The site employs Ms. Wilson to be the host for segments on obesity, and
she said she allowed the operation to be shown on the Web to educate
the public about surgical treatments for her condition. Ms. Wilson, who
said she weighed almost 300 pounds before the surgery, has lost 30
pounds since the and expects to lose 80 more.
She said she wasn't disturbed by having the operation shown on the
Internet. "I come from a famous family," she said. "My whole life has been
exposed."A couple of weeks ago, celebritydoctor.com (billed as "the first
celebrity Website on the Internet") said that one of its doctors would
perform a face lift on Arabella Churchill, the former British prime
minister's granddaughter. Ms. Churchill, who runs a small child-relief group in
England and is getting the procedure free, appeared last month on "Good
Morning America."
"She's an inspiration," said Michael Sands, a former model who owns
-celebritydoctor.com. Sands, who is based in Beverly Hills, Calif., and
recruits celebrities through blind advertisements in The Hollywood
Reporter, said that Ms. Churchill read about him in a London paper. "Her goal
is not to look like her grandfather, and I think that's something that
people should really be behind."
Gilman, the Chicago professor, pointed out that this is not the first
time people have turned a medical procedure or condition into a status
symbol. Fifteen years ago, he said, people bragged in a similar fashion
about having a heart attack. "It was a sign that you were an A-type
personality, that you had so much on your plate that it had given you that
stress."These days, Gilman says, some people flaunt surgical alterations to
convey that they have the means to keep up appearances, like wearing a
Prada dress. But why do people watch? Of course, some viewers are
educating themselves to prepare for an imminent operation. But there's also the
cooking-show appeal. Just as some noncooks love to watch chefs create
magic in the kitchen, as a substitute for preparing meals, on-line
surgery entices some viewers with an element of fantasy.
"What other kind of surgery do people dream of being able to have?"
asked Seth Warshavsky. Warshavsky, 25, is an entrepreneur who owns several
dozen Web sites, including onlinesurgery.com and ClubLove.com, which
shows live sex acts and celebrity sex videos and is widely acknowledged
as one of the Internet's few truly profitable ventures. "Nobody dreams
of having a coronary bypass."
There are similarities, he said, between ClubLove.com and
onlinesurgery.com, which is his second-most popular site (between 10,000 and 15,000
visitors each month view the archival footage, he said, and that number
shoots to 30,000 during twice monthly live surgeries). "They both get
inside a world that is forbidden, essentially controversial. They both
make you feel a little uneasy and excited. It's like watching the Monica
video or new footage from Kosovo."
There are those who wonder if offering live esthetic surgery as
prime-time programming -- not to mention celebrity sex -- isn't taking the new
openness too far. Ms. Kron, the writer, called the Webcasts a "blood
sport." "People watch them to see if the doctors will make a mistake,"
she said, "a slip of the hand."
Gilman predicted that the showing of live procedures would result in a
backlash. "With so many people getting this surgery, soon you will have
a community of people who define themselves by refusing to get it," he
said. "The most powerful statement will be remaining unchanged."
For now, though, onlinesugery.com has no problem finding patients: the
operations are free for patients. Dr. Michael Elam, a southern
California otolaryngologist who has performed most of the operations on the Web
site (his office is equipped with cameras and lighting, like a
television studio), said he gets about 100 e-mails a day from candidates. He
has a full-time assistant who screens the requests for "need."
Press releases made by Warshavsky's staff stress each patient's
poignant story. Elam, whose private practice has benefited from the online
publicity, is working on a way to incorporate a before-and-after element
to the show. He'd like to begin each new surgery with video of former
patients, charting their recoveries.
Elam had his medical license revoked by the California Medical Board
for several years during the early 1990s for illegally billing insurance
companies for ineligible cosmetic surgery. It was reinstated in 1996
with two years probation, which he completed last year.
Elam, who is not certified as a plastic surgeon by the American Board
of Plastic Surgery but can still legally perform the procedures, does
not always see his online patients until the day of surgery, a practice
that the American Society of Plastic and Reconstructive Surgeons says is
unprofessional."How can you possibly know if the person is a good candidate for
surgery if you don't examine them before saying yes?" said Dr. Paul Schnur,
the president of the society.
The society has no official stand against online surgery ("We think
it's tacky, but it's not unethical," Schnur said ), but it has censured
surgeons who give free procedures in any sort of contest or lottery.
Elam, however, is not a member of the society and is beyond its
censure. For him, such concerns are dwarfed by how much his online
performances have boosted his practice: he now does as many as six procedures a
day."If we didn't do it online, we probably wouldn't have a practice like
this today," he said. "People like to see you up on a screen. They trust
you more because they feel they know you, but you're still up there on
the screen. It's like the movies. The technology is new, but in a way,
it's an age-old story."

Cosmetic Sugery Boom: ASPS

Plastic surgeons aid in the war against time
By Paul Schnur, MD, 1999 ASPS President, andC. Lin Puckett, MD, 2000 ASPS President

There was a time when only Hollywood starlets
had their "own" plastic surgeon. There was also a time when owning a big
screen TV or belonging to a health club was an impressive status
symbol. But it's the dawn of a new century, and these days, it's not unusual
for people on any given block to have a large screen TV, work out at
the health club three days a week and, yes, visit a plastic surgeon for a
"touch up" on occasion.As medical technologies have boomed over the
past two decades, plastic surgery has made incredible advances both in
reconstructing accidental injuries and congenital deformities and in
helping erase the marks, wrinkles and sags of encroaching age. Whether it's
fixing a portion of the body to make it look normal (reconstructive
plastic surgery) or improving a "normal" facet of the body to make it look
even more aesthetically pleasing (cosmetic plastic surgery) the goal of
the plastic surgeon is to help the patient look good and feel good
about him or herself. And last year alone, more than a million Americans
found a plastic surgeon certified by the American Board of Plastic
Surgery to help them with everything from erasing a tattoo to lifting a face
to augmenting breasts.High-tech miraclesThe plastic surgeon's arsenal
includes modern technologies like scar-minimizing endoscopes,
fat-melting ultrasound and wrinkle-erasing lasers. Treatments can range from
skin-smoothing acid peels to surgical "lifts" and implants to fat-removing
liposuction. In the war on age, sometimes a combination of all of these
treatments is used to roll back the gnarled hands of time.
No one is safe from the crow's feet of time, but for
many, plastic surgery can be the answer to soften their tracks.
Coming of age
Plastic surgery has seen an amazing growth in popularity in recent
years. These days men and women discuss having nose jobs, facelifts and
tummy tucks to look their best for the corporate image
battlegrounds.But the most important war patients face is over seeing themselves
externally as pleasingly as they see themselves internally. As any good
plastic surgeon will stress, plastic surgery shouldn't be done to impress
others, it should be done to make you feel good about yourself. And more
and more people are using plastic surgery to improve their
self-image.News media reports reinforce a recent survey by ASPS that found cosmetic
surgery procedures performed on baby boomers rose from 164,662 in 1996,
when the first "boomers" turned 50, to 242,427 in 1998. Seniors also
increased their use of cosmetic procedures in this period. The most
popular procedures for both age groups are eyelid surgery, facelifts,
liposuction and laser skin resurfacing.

Online Dairy of Plastic Sugery

http://www.talksurgery.com/consumer/stories/story00000058.html

A New Body, a New Life!
For as long as I can remember, I have been unhappy with the shape of my thighs. Despite
watching my diet and exercising regularly, I had extra fat deposits on my inner and
(especially) outer thighs.
I had a hard time wearing pants because my waist was much smaller than my bottom half.
Finally, after a lot of research, I decided to have the procedure done. I met with a
couple doctors, and then found one who I immediately clicked with. One month later, I
had the surgery.
After I had healed, I was disappointed that there wasn't that much of a difference. You
have to be patient, because I discovered that my body was still changing 10 months
later. Now, a year and a half later, I am very satisfied with the way I look. I went
from a size 6 to a size 2. My pants finally fit well in the waist and the thighs! I
would have the surgery again in a second; it has changed my life.

Bibliography