Cosmetic Plastic Surgery Today
Plastic surgery pursues both aesthetic and functional objectives, sometimes accomplishing both simultaneously. When it focuses primarily on improving or restoring function, it is referred to as “reconstructive” surgery. Reconstructive procedures include the repair of scars and lacerations, tumor removal, post-surgery reconstructions and tissue repair for burn victims, and an improved appearance is often a secondary benefit of many reconstructions.
In cosmetic surgery, however, improved appearance is the primary, if not the only, goal. This is a crucial distinction in contemporary surgical practice, because health insurance rarely covers procedures like cosmetic surgery that it considers “elective.”
Despite the lack of insurance coverage, cosmetic procedures are increasingly popular. According to the American Society of Plastic Surgeons (ASPS), the number of procedures of all kinds performed in the United States grew 69 percent from 2000 to 2009. ASPS acknowledges, however, that most of the ongoing growth entails minimally invasive procedures and that the number of more costly traditional surgical procedures has fallen some 20 percent during that same period. Regardless of the recent downturn, cosmetic procedures as a whole accounted for $10 billion in U.S. spending in 2009.
COMMON PROCEDURES AND TECHNIQUES
The most common procedures have not remained constant over the years, especially as more invasive surgical options have given way to simpler procedures that are faster and less expensive, if capable of less dramatic results. That trend is readily illustrated by comparing the five most popular procedures in the surgical category with treatments that are considered minimally invasive.
Cosmetic & Plastic Surgical Procedures & Techniques
Breast augmentation
is the single most common cosmetic surgical procedure performed in the United States, although its popularity fell six percent from 2008 to 2009 after increasing 36 percent since 2000. Its history dates to the late 19th century, but it was not until the 1960s that successful prosthetic implants were developed.
The typical procedure involves the placement of an implant filled with either saline or silicone material through an incision. The incision can be made in several locations, and each approach has its own characteristics. The most common site is beneath the breast, which allows for precise placement of the implant but may leave scars that are more visible. Incision at the border of the areola may leave less noticeable scars but can interfere with breast-feeding. Placement through an incision made in the armpit does not scar the breast, but is the most difficult route for precise placement. Breast augmentation costs between $3,500 and $3,800 according to the ASPS.
Rhinoplasty
while still the second most common procedure, has decreased in popularity by 34 percent between 2000 and 2009. It entails reshaping the nose by either an open or a closed method. In closed rhinoplasty, incisions are only made inside the nose. Open rhinoplasty adds an incision at the point between the nostrils. In case, the bone and cartilage is reshaped, sometimes with the aid of a graft of the patient’s own cartilage taken from another site. The average cost of rhinoplasty is $4,277.
Blepharoplasty
or eyelid surgery, is also among the procedures whose popularity has consistently decreased, in this case falling eight percent from 2008 to 2009 and 38 percent from 2000 to 2009. In eyelid surgery, the lids are reshaped by removing fat and excess skin in order to eliminate wrinkles and, especially in the lower lids, puffiness. Incisions can be made either externally or internally depending on the precise result desired. Eyelid surgery costs on average $2,882.
Liposuction
the most common surgical procedure in 2006 with almost half a million patients, has also fallen in popularity, declining 19 percent from 2008 to 2009 and 44 percent from 2000 to 2009. The procedure involves the removal of fat from almost any area of the body by using a hollow tube called a cannula attached to a device that provides suction. Various techniques are used to loosen the fat so that it can be removed, including the simultaneous injection of water and the use of ultrasound. The average cost is $2,868 according to the ASPS.
Abdominoplasty
known as a “tummy tuck,” has seen an 84 percent increase in popularity from 2000 to 2009 and retained much of that popularity between 2008 and 2009, falling only five percent. While it can vary in extent, in essence abdominoplasty involves an incision just above the pubic bone that allows access to the abdominal muscles, which are tightened with sutures. Excess abdominal skin is then removed and the remaining skin is sutured back into place. The procedure is sometimes combined with liposuction for further contouring of the shape, or with more extensive cosmetic procedures, including breast augmentation or reduction. Abdominoplasty costs $5,263 on average.
Minimally Invasive Cosmetic Procedures & Techniques
Botulinum toxin
best known by its trade name Botox, saw its use decrease four percent from 2008 to 2009 after a 509 percent increase from 2002, when the Food and Drug Administration first approved its use, to 2009. Minute quantities of the substance are injected into the face to paralyze those facial muscles that would otherwise contribute to the formation of wrinkles. The effect usually persists for three to four months. In 2007, Botox injections overtook liposuction as the most popular cosmetic procedure performed in the United States, with almost five million Botox treatments. Since individual states permit Botox administration by providers at different qualification levels, including dermatologists, nurses and physicians assistants, costs vary significantly. According to the ASPS, the average charge is $417.
Soft tissue fillers
grew seven percent from 2008 to 2009 and increased 164 percent for the decade. The procedure can be used both to fill lines and wrinkles in the face and to augment and reshape features, especially the lips. Many types of fillers are used, including collagen, hyaluronic acid and fat harvested from the patient’s body, each working best for a particular area and each yielding results of different duration. The cost of soft tissue filler treatment is approximately $1,450.
Chemical peels
saw little change in popularity from 2000 to 2009, but their use decreased nine percent from 2008 to 2009. They are used to minimize fine wrinkles and to remove blemishes, freckles and various signs of age and sun damage. Treatment involves applying an acid solution to the face, which can be done in an office visit, especially if milder acids are used. Stronger peels are sometimes done in the hospital where general anesthesia is available. Chemical peels cost $870 on average.
Microdermabrasion
use increased eight percent 2008 to 2009 and grew by five percent over the course of the decade. The procedure involves directing a spray of fine crystals at the face to remove fine wrinkles and discoloration. Results may require several treatments to be noticeable, but the procedure is perhaps the least invasive and least painful of all of the most common treatments. In addition, its use is not restricted to plastic surgeons and it is available at salons and spas, and even in kits for home use. Cost per treatment averages $162.
Laser hair removal
was unchanged in popularity between 2008 and 2009, but its use increased 21 percent during the decade. The treatment relies on the ability of laser energy to target dark areas and leave light areas untouched, which allows it to remove unwanted black or brown hairs. Lighter colored hair is less susceptible to laser removal by virtue of the different chemicals that contribute to its color and the frequent lack of contrast between hair color and skin tone. An initial set of up to eight treatments may be required, followed by touch-up treatments since patients’ responses differ greatly. The cost of laser hair averages $373.
TRENDS
Two major trends can be discerned from a review of the most common cosmetic surgery procedure: a decline in the major surgical procedures and a marked increase in many of the minimally invasive options.
There may be more to the story, however. According to an April 2010 survey, 69 percent of respondents evinced an interest in cosmetic surgery if money were not an obstacle, compared with 54 percent of respondents who were asked the same question in November 2009.
The future may be bright as well. A 2008 survey reported that cosmetic surgery garnered the highest approval rating among young adults aged 18 to 24, with 69 percent of those surveyed indicating their approval. This represented a seven percent increase from results reported in 2006.
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