the new face of cosmetic surgery

It wasn’t that long ago the words “plastic surgery” were whispered.  In contrast, last month just fewer than 3 million Americans eagerly tuned in for the season finale of Nip/Tuck, in which two sexy plastic surgeons navigate moral gauntlets in between vivid liposuction procedures and breast augmentations.

Of those local baby boomers who watch programs like Nip/Tuck and Dr. 90210, many of them - women and men - are having their own consultations on how to achieve an outer body that matches their inner spirit

“People in Florida are healthy, with healthy lifestyles,” says Dr. Patrick Flaharty, of Azul Cosmetic Surgery and Day Spa. “They feel good, but as they’re aging, they see an older person in the mirror.  The disconnect is what bothers them. So I think that’s an impetus for a lot of people, who are active and feel good and healthy, to come in for facial rejuvenation.”

The term "rejuvenation" is a telling sign of evolution: baby boomers have seized upon the concept of bodily selfimprovement with such verve and entitlement that even the industry's lingo has changed. 'Plastic surgery' is out, 'rejuvenation,' is in, following the long-held baby boomer mantra of 'If it feels good, do it.' And anyone seeking justification won't have far to look: feeling good about one's self is preached daily by authors, psychiatrists, talk show hosts, parents and teachers.

While celebrities may sneak through back entrances to get even non-surgical work done, many southwest Floridians enjoy the bragging rights that come with partaking in 15-minute lunch-hour treatments. For many, there's no longer anything 'plastic' about wanting to look good; it's just considered healthy for the spirit.

FLAHARTY

In several cases, it's also good for business, which accounts for the increase in both women and men now seeking their own exterior improvements. "We do see more men," says Flaharty. "Now it's not really rare at all." Male patients span a vast spectrum but include many professional men in their 50s, seeing their first serious signs of aging.

Dr. Ralph Garramone, another Fort Myers-based boardcertified plastic surgeon, says his male patients "tend to have lipo (liposuction) of their abdomen and flank areas."

Man oh man

Men routinely decide to attack droopy eyelids, and face and neck lifts are also quite common, when the heaviness of the jowls and neck starts to make men look older. "Loose skin hanging over the collar doesn't give men the image they want, professionally speaking," says Flaharty.

Many male patients want to look current in their profession, the doctor explains, confirming it's not just newscasters

GARRAMONE

who worry about the career effects of aging. "Men want to look good so they can compete," Flaharty said, adding that he treats bankers, attorneys, real estate brokers and agents. "I think there's a bias in all the business world toward younger, "Cosmetic surgery is now an acceptable norm," says Dr. Bob Brueck of Associates in Cosmetic Surgery, who estimates that 5-7 percent of his patients are men. "I think most men are very comfortable with it," he says. "Twenty to thirty years ago it was a secret. Now everybody has it done." Many of Brueck's male patients have opted for rhinoplasty (a nose job), but he confirms the popularity, among men, of face lifts and neck lifts, the latter correcting what he calls the 'turkey waddle.'

"Men are also getting lipo for love handles; that is very popular," he says. Men's' chests are a concern to them as well, particularly gynecomastia, or male breast tissue. "So sometimes we suction, sometimes we cut," says Brueck.

Away with it

Brueck also discussed lipo-dissolve injections, which he's even given himself. The doctor simply injects a substance in the body's soft tissue to make fat dissolve and go away. The procedure takes ten to twenty minutes, depending on how many areas a patient wants to address.

BRUECK

"My experience is that lipo-dissolve is not as effective as formal liposuction," warns Brueck "I can't guarantee a percentage. With suction, I'm physically removing fat. How effective the injections will be remains to be seen; that's true with any non-surgical procedure."

After lipo-dissolve injections, patients will experience redness, soreness, swelling and some bruising that can last two to five days. Once some of that swelling goes down, people may feel nodules where they had the injections, which is normal. The fat cells are breaking down, and the 'nodule' feeling can take several weeks or months to go away. Brueck feels that lipo-dissolve usually produces good results on stomachs, but hips don't respond.

Fillers and the quick fix

Our recent embrace of the industry also handily coincides with (or has perhaps generated) the myriad new, non-surgical techniques available today. Temporary fillers like Restylane, Juvederm and Radiesse are all the rage to immediately reduce creases and fill in sagging hollows.

Injectable fillers are popular because there's very little down time. And the results are immediately visible, to both patients and their partners. "You never quite know if men are coming in on their own," says Garramone, "or because they've been hearing from their wife or girlfriend that they're looking tired." Many of his patients relate similar comments, which spurred them to action.

Results will vary from patient to patient, and different body parts even react differently to the same substance. It's important for patients to understand that everyone will respond differently to non-surgical procedures. Injections for two different people, at the same time, from the same vial, will last a different amount of time. Recovery times also vary from person to person.

Motivations will also vary. "It's not uncommon for men to come in for Botox," says Garramone. "And Botox patients come in because people think they look angry. They have a constant frown line." He goes on to reveal that Botox is not a filler, it's a medicine. "It weakens or paralyzes the muscle that it's injected into, limiting the muscle movement which causes dynamic lines."

Because medical technology and procedures are advancing so rapidly, for the next eight weeks, Florida Weekly will highlight the latest advancements in local medicine. NEXT WEEK: Ophthalmology.

Several local medical spas and clinics now offer laser hair removal as well, a popular treatment utilized primarily by women but also by men. "There is no way to permanently eliminate hair," says Garramone, "but what you get is a significant reduction. You may come back once a year for a few scragglers that you can treat. Guys can do that on their backs, shoulders and ears."

The photo facial is another quick fix with little to no down time. Basically a bright flash of light energy absorbed by the reds and browns of the skin, the photo facial targets age spots and sun spots. Surface skin is not removed, but the skin's redness, flushing, dilated capillaries, burst vessels and unsightly spots are lessened or erased. This treatment actually works anywhere on the body, including hands, face, arms and chest. It's quick and effective.

Laser resurfacing, by contrast, removes sun-damaged surface skin and tightens deeper layers. The immediate effect will look like a sunburn, and can take ten days to two weeks to heal. Face- and neck-lifts take one to two weeks' recovery time, depending on the associated swelling.

Injectable fillers to erase lip lines, are quick to receive and only slightly painful, but require 48 hours of ice packs and little mouth movement for two days.

Choosing with care

Southwest Floridians' increasing familiarization with the ins and outs of this rapidly-changing industry is underscored by an ever-increasing number of local practitioners. "There were four of us here 30 years ago," says Brueck of a select group of local peers. "Now there's a ton of them." A quick check of the yellow pages confirms his observation, with nearly 20 listings in the Fort Myers area alone.

Local board-certified surgeons - who must take hundreds of hours of continuing education on a regular basis - worry about the patients having cosmetic work done by their family practitioners and others. "The problem is this," explains Brueck. "If the patient goes in to see a non-certified plastic surgeon, he's very limited in the procedures he's offered." A board-certified plastic surgeon, on the other hand, can discuss all options from a to z. He or she can tell the patient what will meet their needs, both financially, and in regard to expectations. "Some people will spend several thousands on fillers," Brueck says, referring to injectable fillers' wide availability, "when what they need is a facelift."

A conservative approach

Despite the ever-expanding menu of scientific breakthroughs, many cosmetic surgeons maintain a conservative approach, even in the face of new products which promise a permanent fix. Artefil, for example, is the first FDAapproved permanent filler. Temporary fillers last anywhere from three months to a year or more, and must be repeated to maintain a look. Injections of Artefil, however, plump up creases with tiny, synthetic beads that can't be seen or felt, but which last forever.

"The beads won't go away, but the skin does continue to change," says Flaharty, referring to the aging process. "The patient will lose tissue over time. So you don't want to do something that will look great in the short run," he says, "but won't look good in the long run. People only think they want permanence." Another consideration is brought up by Dr. Garramone, who explains that Artefil comes mixed with collagen, and requires a skin test; patients have to wait a month for the results of the test before getting an injection, to ensure they have no allergy to collagen.

The very latest 

Another new injectable solution is Sculptra, which has its base in a familiar product. "It's the material that dissolving stitches are made of," says Garramone, "and they've made it an injectable material. It creates a situation after it's injected, where your body forms collagen around those particles. And you're left with your own collagen; it becomes the filler, if you will." Sculptra requires a series of injections, so is more expensive, and there's a waiting period, while one's own collagen production is stimulated. Results can thus take up to three months.

Thermage uses radio waves to create heat in and under the skin, activating the building of collagen, and tightening the skin. "But now they've come up with a tip which can treat cellulite," says Garramone. "They're showing some pretty good results, so I'm interested to try that."

cosmetic surgery trends

>> Top cosmetic procedures in 2006:

SURGICAL Liposuction Breast augmentation Eyelid surgery Abdominoplasty Female breast reduction

NONSURGICAL
Botox®
Hyaluronic Acid (Hyla form, Restylane)
Laser Hair Removal
Microdermabrasion
Laser Skin Resurfacing

>> For women:

SURGICAL Lipoplasty Eyelid surgery Abdominoplasty Breast Reduction

NONSURGICAL
Hyaluronic Acid (Hyla form, Restylane)
Laser Hair Removal
Microdermabrasion
Sclerotherapy

>> For men:

SURGICAL Liposuction Rhinoplasty Eyelid surgery Male breast reduction Facelift

NONSURGICAL
Botox injection
Laser hair removal
Hyaluronic Acid (Hyla form, Restylane)
Microdermabrasion
Laser Skin Resurfacing

- Source: American Society for Aesthetic Plastic Surgery