Topic Overview

What are cosmetic surgery and procedures?

Cosmetic
surgery and procedures change, restore, or enhance your appearance. There are
many reasons for wanting to change or enhance your looks. If you have had burns
or other injuries, were born with a birth defect, or want to change parts of
your body for other reasons, you may choose to have a cosmetic surgery or
procedure.

What are the general types of cosmetic surgery and procedures?

Cosmetic surgery commonly
includes:

  • Reconstructive surgery. This is typically done to improve a visible scar, skin
    condition, or malformed body part caused by an injury, a surgery, a disease, or
    a birth defect. These problems can affect your day-to-day life, including your
    job, your relationships, and your self-esteem.
  • Elective cosmetic surgery. Being unhappy with something about
    your appearance-such as a large nose, small breasts, wrinkles, or fat around
    your belly or hips-is a common reason for choosing to have cosmetic surgery. These kinds of things don’t bother everyone who has them. But for some people, these things can affect
    their self-image or confidence. Cosmetic surgery is one way to address them.

Nonsurgical cosmetic procedures
include:

  • Botox injections.
  • Fat deposit removal, either with injectable deoxycholic acid (Kybella) or by freezing fat cells below the surface of the skin with a handheld device (CoolSculpting).
  • Filler injections, which include soft tissue fillers.
  • Laser hair removal.
  • Laser resurfacing to improve acne
    scars.
  • Sclerotherapy
    injections for small
    varicose veins and
    spider veins.
  • Teeth whitening.

This topic focuses on elective cosmetic surgery and
procedures rather than reconstructive surgery.

Why are these surgeries and procedures done?

For
most of us, our physical appearance affects how we see ourselves and how others
see us. The size, shape, and look of our bodies may affect how we feel about
ourselves and even how we live our lives.

There is nothing wrong
with wanting to change the way you look. Some people do this through diet,
exercise, and other lifestyle changes. Others have cosmetic surgery, especially
if they are unhappy with a certain part of their body or appearance that can be
changed.

What are the risks?

Think carefully about the
decision to have cosmetic surgery. Surgery always involves some risk. The risks
depend on your health and the type of procedure you have. They can range from
slight scarring to infection and even death. Serious problems are rare, but
they can occur.

Also, there is no guarantee that you will get the
results you want. More than one procedure may be needed. Results are lasting unless you have surgery again. Talk with
your doctor about the possible risks and benefits of the surgery.

Who pays for this surgery?

Insurance rarely covers
the cost of elective cosmetic surgery and procedures. Unless the surgery is
done for medical reasons, you will probably have to pay for it yourself.

These surgeries and procedures can cost a lot. Be sure that you
know the total cost of the surgery, including the costs of the procedure
itself, any medicines you’ll need before or after the procedure, follow-up
treatments, office visits, and other expenses.

Are cosmetic surgery and procedures right for you?

Surgery should not take the place of good health habits. There are steps
you can take to help you look and feel young and healthy.

  • Eat healthy foods.
  • Get plenty of
    exercise.
  • Limit how much time you spend in the
    sun.
  • Protect areas of your skin that get the most sun, such as the face, back of the hands, and upper chest or neck.
  • Manage stress.
  • Don’t smoke.
  • Avoid
    drugs and excess alcohol.

Be sure to have realistic expectations about how cosmetic
surgery may or may not affect your life. For people who are unhappy with their
overall appearance rather than just a certain part of their appearance,
cosmetic surgery is probably not the answer. These people are unlikely to be
happy with the results of just one cosmetic surgery procedure. They may end up
having one procedure after another, which can be harmful and expensive.

Before you choose to have cosmetic surgery, think about your overall
health. Remember that all procedures have risks. And having a health condition
such as
high blood pressure or heart disease may increase the
risk.

Talk to your doctor if you are thinking of having a cosmetic
procedure or surgery.

Surgery Options

You may have several
cosmetic surgery or procedure options to enhance or
restore your appearance. Talking with your doctor can help you choose the
option that best fits your needs.

Common cosmetic procedures

  • Laser resurfacing uses a laser light to
    heat, damage, or destroy the upper layers of the skin. This can tighten the
    skin or cause new skin to grow. It is typically used to remove or improve the
    appearance of wrinkles, brown spots, shallow scars (from acne, surgery, or
    trauma), and sometimes, the appearance of small veins. Tattoos are removed with surgery or a laser that
    breaks down the color into fragments. These fragments are removed by your
    immune system.
  • Chemical peel uses a chemical solution to remove the
    top layers of skin, allowing new skin to grow. It is most often used to remove
    wrinkles, superficial skin growths, shallow scars, pigment changes in the skin,
    and other skin problems.
  • Dermabrasion
    uses a fine wire brush or a diamond wheel with rough edges to remove the upper
    layers of the skin, allowing new skin to grow. It may be used to treat acne
    scars and wrinkles around the mouth or to treat an enlarged nose (rhinophyma) caused by
    rosacea (facial inflammation and
    redness). Microdermabrasion uses a different technique to treat just the top layers of the skin.
  • Filler injections are used to
    smooth wrinkles or pitted scars in the skin. They are also used to make the
    lips fuller. Fillers can restore volume and structure that is lost due to age or weight loss. When injected under the skin, a filler raises or puffs up that
    area. This goes away with time.
  • Botox injections
    use a protein that weakens the muscles of the face to reduce wrinkles. The
    effect is temporary, lasting about 3 to 4 months.
  • Sclerotherapy reduces or removes the appearance of
    small varicose veins and
    spider veins. In sclerotherapy, a chemical is injected
    into a vein to damage and scar the inside lining of the vein, which causes the
    vein to close.
  • Laser hair removal and electrolysis permanently remove
    unwanted hair such as facial hair. In laser hair removal, light treatments are used to heat and destroy hair follicles. This reduces the number of body hairs. In electrolysis, an electric current is
    applied to the hair root, which heats and destroys the hair follicle. Hair is
    not able to grow back in this area.
  • Medical tattooing uses tattoo
    ink to change the look of a medical problem. For example, it can be used after
    breast surgery to create the look of a darker nipple and areola. Medical
    tattooing can also be used to darken white skin patches (vitiligo) and scarred
    skin.

Common cosmetic surgeries

  • Face-lift (rhytidectomy) removes excess
    skin and fat and tightens the muscles to smooth the face. Improvement is
    especially seen along the jawline and in the neck.
  • Eyelid surgery (blepharoplasty) removes excess skin, fat, and
    muscles from the eyelids to correct drooping eyelids and remove bags and
    puffiness. Surgery may be done on the upper and lower lids.
  • “Nose job” (rhinoplasty) reshapes the nose by removing or rearranging its
    cartilage and bones. Rhinoplasty is done to change the appearance of your nose,
    improve breathing and nasal function, or achieve a combination of
    both.
  • Breast enlargement (augmentation) places an implant
    under the breast tissue or the chest muscle to make the breast
    larger.
  • Breast reduction removes excess breast
    tissue and skin to reshape and lift the breast. Women may seek breast reduction
    to change their appearance, reduce back pain, and reduce limitations of
    activities caused by large breasts.
  • Liposuction uses
    suction, ultrasound, or laser to remove stubborn fat that has not gone away with a healthy weight
    loss diet and exercise. For women, this can be on the outer or inner thighs,
    neck, upper arms, belly, knees, and hips. For men, this can be on the waist,
    belly, neck, breasts, or back.
  • “Tummy tuck” (abdominoplasty) removes excess skin and fat
    from the abdominal area and tightens abdominal muscles. When a large weight
    loss or several pregnancies leave behind extra folds of skin, some people use
    this surgery for a flatter, smoother stomach. As with liposuction, the purpose
    of a tummy tuck is to reshape the area rather than to reduce body
    weight.
  • Varicose vein surgery removes large
    varicose veins. During varicose vein surgery, an
    incision is made over the varicose vein, and the vein is tied off and either
    left in place or removed. But newer therapies for vein stripping include foam sclerotherapy and laser or radiofrequency probes that use heat to destroy varicose veins.
  • Hair transplant surgery reduces the appearance of bald spots or hair loss by moving hair
    from one part of the head to another.

Important Considerations

If you are thinking about
having
cosmetic surgery or a cosmetic procedure, consider the
following questions before making a decision.

Why do you want cosmetic surgery?

This is an
important question. Take the time to think it through. Cosmetic surgery
involves risk and expense. It can permanently change your physical appearance,
possibly in a way you didn’t expect or that leaves you unhappy. Make sure that
cosmetic surgery is what you want. It is not a good idea
to change your appearance because someone else wants you to or because you
think it will help you get a particular job. If you are content with your
appearance, do not let anyone pressure you into having cosmetic surgery. The
decision needs to be your own.

If you are unhappy with your
appearance, consider other ways to approach your “problem” area before deciding
to have cosmetic surgery. For instance, lotions and creams prescribed by your doctor can reduce fine wrinkles. Or makeup may help conceal or de-emphasize
wrinkles, scars, and other skin changes. If you are unhappy with the shape of
your body, changing your dress and clothing style may help you feel better
about how you look. Diet and exercise can often help you achieve the body shape
you desire.

If these measures don’t work for you, then you may
wish to consider cosmetic surgery. Satisfaction levels are generally very high.
Your self-image and attitude toward your own body may improve, which can boost
your confidence and self-esteem. For some people, this feeling may not last over time.

What are your expectations?

You are more likely to
be happy with the results of cosmetic surgery if you have clear, realistic
expectations and a clear understanding of why you want to have surgery. First,
decide exactly what you would like to change or improve. Then discuss those
goals with your doctor, who can tell you whether your goals are realistic and
how best to achieve them. Looking at photographs of desirable features may help
you decide what you want. Remember, though, that cosmetic surgery is used to
enhance your own features and not necessarily to duplicate those of another
person whose physical appearance you admire.

Get the facts about
what to expect from a certain procedure. Have your doctor show you
photographs and explain the full range of possible results. Computer imaging
can be helpful, but it can also be misleading. There is no guarantee that the
end results will match those created by the computer. With some types of
surgery, the results may not appear for several weeks or months after the
procedure. It may take several sessions or a combination of procedures to
achieve the look you want. And results are not always permanent.

Remember that the effects of time, gravity, aging, and sun exposure
continue after cosmetic surgery. Surgery is no substitute for good health
habits. Getting proper nutrition and regular exercise, guarding against sun
exposure, managing stress, not smoking, and avoiding drugs and excess alcohol
can go a long way toward helping you look and feel young and healthy.

Try to have realistic expectations about how cosmetic surgery might
affect your life. Changing an aspect of your body that you are not happy with
may make you feel more attractive, more satisfied with your appearance, and
freer to do things that in the past made you uncomfortable, either emotionally
or physically. For some people, the impact may be dramatic. But don’t expect
cosmetic surgery to solve all your problems. It may change how you look and
feel, but it won’t change who you are.

Talking with someone who
has had cosmetic surgery may raise issues that you had not considered. Ask how
the person felt about the results, whether the surgery achieved the results
hoped for, and what the total experience was like. Doctors who have experience
with cosmetic surgery can also provide perspective on the issues
involved.

What can you expect during recovery?

Some types of
cosmetic surgery are simple
outpatient procedures that allow you to return to your
regular activities right away. Others may require you to take days or even
weeks off work. Be sure that you understand what your recovery will involve and
that you are able to follow your doctor’s instructions. Important questions to
ask include:

  • How long will recovery take? How soon will I
    be able to return to work or school?
  • Will the recovery be painful?
    What other side effects (bruising, swelling, itching, numbness) will I have,
    and how long will they last?
  • What will I have to do to help my body
    heal properly? For example, skin resurfacing often requires a very thorough
    skin care routine during recovery. If you have a face-lift or nose surgery, you
    may have to keep your head elevated and avoid certain activities for a period
    of time. Following or not following these instructions can affect the results
    of the procedure.

What are the risks of cosmetic surgery?

Although
many types of cosmetic surgery have very few risks, no procedure is risk-free.
The risks vary according to your health and the type of procedure being
done. They can range from slight scarring to infection and even death. Serious
complications are rare, but they can occur.

It is possible that
you may be putting your health and life at unnecessary risk when you have
cosmetic surgery. It’s important to weigh the risks against the possible
benefits.

The other major risks of cosmetic surgery are that it
may not produce the changes you want and that it may produce changes that leave
you even more unhappy than you were before. Additional treatment may be needed
to correct the results of the initial surgery. But the results of cosmetic
surgery are often irreversible.

Who pays for cosmetic surgery?

Insurance rarely
covers the cost of elective cosmetic surgery done to improve appearance.
Reconstructive surgery may be covered if it will improve your physical function
or will correct a problem present from birth (congenital) or caused by an
accident. But unless cosmetic surgery is done for medical reasons, you will
probably have to pay for it yourself.

Examples of cosmetic surgery
done for medical reasons that may be covered (or partially covered) by
insurance include:

  • Treatment of severe scars or disfigurement
    caused by disease, injury, or birth defects.
  • Fixing ears that stick out too far.
  • Breast reduction when
    large breasts cause pain or severely limit a woman’s
    activities.
  • Breast reduction of large breasts in men.
  • Reshaping of the nose (rhinoplasty) to improve
    breathing and nasal function.
  • Breast reconstruction after surgery
    to remove
    breast cancer (mastectomy).

Cosmetic surgery can be quite expensive, especially when
you are paying for all of it out of your own pocket. Be sure that you know the
total cost of the surgery, including the costs of the procedure itself (such as
surgeon fees, anesthesia fees, and operating facility fees), any medicine
before or after the procedure, follow-up treatments, office visits, and other
expenses.

Also be prepared to cover costs resulting from
complications during or after surgery or the need for “touch-up” surgery.
Insurance may not cover treatment for complications that arise from
cosmetic surgery. Some procedures, including skin treatments, liposuction, and
breast enlargement, may have to be repeated as time goes by, to maintain the
results. You will have to pay for these repeated treatments just as you paid
for the initial treatment.

Choosing a Surgeon and Facility

Finding a cosmetic
surgeon that you have confidence in and are comfortable talking to is extremely
important when you are considering
cosmetic surgery or procedures. You and your doctor
can work together to build a treatment plan that both meets your needs and is
realistic.

You may want to schedule a consultation with a cosmetic surgeon. Many cosmetic surgeons offer free or low-cost consultations. Sometimes a consultation fee is applied to the cost of the surgery.

No other single thing may influence the results of cosmetic
surgery as strongly as the doctor’s level of experience. Don’t be afraid to ask
about the doctor’s experience with the procedure you are
considering. Request before-and-after photographs of other people who have had
the procedure done. And ask to see the worst results as well as the typical and
best results.

Doctors with special training in cosmetic surgery
should be board-certified by the American Board of Plastic Surgery or the
American Academy of Facial Plastic and Reconstructive Surgery.

Take your time finding a cosmetic surgeon that you like and trust. Ask your
doctor for recommendations. And contact the American Society of
Plastic Surgeons, the American Academy of Facial Plastic and Reconstructive
Surgery, or the American Society for Aesthetic Plastic Surgery for a list of
qualified surgeons in your area.

You will have a greater chance of
being happy with the results of cosmetic surgery if you find a cosmetic surgeon
who listens to you and understands what you want to achieve. People differ in
what they consider an “ideal” face, nose, breast, or body type. Your and your
doctor’s vision of what is ideal may not be the same. Make sure that your
doctor understands what you want. Also remember that cosmetic surgery is done
to enhance your own appearance and not necessarily to duplicate that of someone
whose physical appearance you admire.

It is important to
understand and accept what can and cannot be achieved with cosmetic surgery,
based on your skin or body type, age, medical history, the surgeon’s
experience, the limits of technology, and other things. A good cosmetic
surgeon can help you understand how these things affect your cosmetic surgery
options.

Any licensed medical doctor can legally perform cosmetic
surgery, but the levels of training and experience in cosmetic surgery vary
widely. For your own safety, avoid doctors who are not board-certified, and
look for a cosmetic surgeon with a lot of experience. Doctors who most commonly
do cosmetic surgery and procedures include:

  • Plastic and reconstructive surgeons.
    These doctors are board-certified specialists in cosmetic surgery and
    reconstructive surgery and have multiple years of training in these fields. All
    members of the American Society of Plastic Surgeons are board-certified by the
    American Board of Plastic Surgery.
  • Otolaryngologists, also called ear, nose, and throat
    (ENT) specialists. Many of these doctors have additional training in cosmetic
    surgery of the head and neck and may belong to the American Academy of Facial
    Plastic and Reconstructive Surgery.

You may also check the credentials of any
outpatient surgery center that you are considering, to make
sure it is safe and reliable. Look for clinics that have a well-established
track record for good results and high-quality service, and avoid those that do
not. The facility should be licensed by the state in which it is located and
accredited by a nationally recognized accrediting organization. To check a
facility’s accreditation status, contact the American Association for
Accreditation of Ambulatory Plastic Surgery Facilities (www.aaaasf.org), the
Accreditation Association for Ambulatory Health Care (www.aaahc.org), or the
Joint Commission on Accreditation of Healthcare Organizations
(www.jointcommission.org).

Other sources of helpful information include
consumer health groups, people who have had cosmetic surgery, other doctors,
books and articles, and the Internet. But do not put too much trust in
before-and-after photos you may find on the Internet. Some may have been
altered by computer or are likely to represent an extremely positive result,
not necessarily a typical result. In either case, before-and-after photos on
the Internet may give you a false impression of the results you can
expect.

Cosmetic surgery is not an emergency procedure, so there
is no reason to rush into it. Do not be pressured into making a quick decision.
Get as much information as you need to feel comfortable about your decision.
Don’t be afraid to get a second and even a third opinion, especially if you are
not completely comfortable with your first doctor visit.

Other Places To Get Help

Organizations

American Society of Plastic Surgeons
www.surgery.org

American Society of Plastic Surgeons
www.plasticsurgery.org

References

Other Works Consulted

  • Kontis TC (2009). Scar revision and skin resurfacing. In JB Snow Jr, PA Wackym, eds., Ballenger’s Otorhinolaryngology Head and Neck Surgery, 17th ed., chap. 57, pp. 707-715. Hamilton, ON: BC Decker.
  • Kontis TC, Rhee JS (2009). Rejuvenation of the upper face and midface. In JB Snow Jr, PA Wackym, eds., Ballenger’s Otorhinolaryngology Head and Neck Surgery, 17th ed., chap. 60, pp. 741-748. Hamilton, ON: BC Decker.
  • Losee JE, et al. (2015). Plastic and reconstructive surgery. In FC Brunicardi et al., eds., Schwartz’s Principles of Surgery, 10th ed., pp. 1829-1894. New York: McGraw-Hill Education.
  • Murakami CS, Ambro BT (2009). Rejuvenation of the lower face and neck. In JB Snow Jr, PA Wackym, eds., Ballenger’s Otorhinolaryngology Head and Neck Surgery, 17th ed., chap. 61, pp. 751-757. Hamilton, ON: BC Decker.

Credits

ByHealthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD – Internal Medicine
Adam Husney, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Martin J. Gabica, MD – Family Medicine
E. Gregory Thompson, MD – Internal Medicine
Specialist Medical Reviewer Keith A. Denkler, MD – Plastic Surgery

Current as ofOctober 5, 2017