Take a look at the reality and implications of cosmetic surgery from the point of view of the patients and the surgeons who undertake such life-transforming work.
21 April 2015| Last updated on 30 January 2018
Recent years have seen a dramatic growth in the uptake of cosmetic surgery amongst people of all nationalities around the world, irrespective of race, colour or creed. What was formerly the domain of the super-rich and celebrities is today accessible to an ever-widening group of enthusiastic patients of more modest means, queuing up to adjust their appearance, correcting little anomalies here and there, and thereby improving their self-image and quality of life in general. At least, that's the theory. This article takes a look at the reality and implications of cosmetic surgery from the point of view of the patients and the surgeons who undertake such life-transforming work.
First of all a few definitions are in order, since many medical and quasi-medical terms are these days bandied about in the media with apparently little thought as to their correct usage and meaning, regularly leaving patients overwhelmed by miss-information and indeed information overload in general. To set the record straight we talked to Dr Allen Rezai, Consultant Plastic and Reconstructive Surgeon of Harley Street, London, and also founder of Elite Plastic & Cosmetic Surgery Group in Dubai Healthcare City, UAE. When asked for a definition of Plastic Surgery, Dr Rezai immediately retorted “I assume that when talking about Plastic Surgery, you really mean Cosmetic Surgery. As normally, Plastic Surgery focuses on repairing and reconstructing abnormal structures of the body caused by birth defects, developmental abnormalities, trauma, infection, tumours or disease, whereas Cosmetic Surgery is a type of Plastic Surgery that alter one’s appearance.”
In addition to a whole range of invasive cosmetic procedures, there is today an ever-growing number of what are classified as “non-surgical” procedures, many of which provide temporary relief from a variety of problems, from wrinkle treatment and the symptoms of ageing through to the treatment of excessive sweating. Such treatments often relate to rejuvenation or anti-ageing and are also the province of many Cosmetic Surgery clinics and their incumbent doctors and surgeons. For example, Dr Rezai's clinic also offers a growing number of non-invasive cosmetic treatments such as Botox, dermal fillers, PRP (platelet Rich Plasma) Therapy, laser and Radio Frequency firming, lifting and rejuvenation treatments, and laser hair removal, all of which are amongst the most popular procedures.
As to the reasons behind the growth in both surgical and non-surgical procedures, not is it solely because of the scientific and technological advances combined with a real terms reduction in cost, but it is also due to the many social pressures and influences to which people are subjected almost 24 hours a day. Indeed these factors influence each other, as increased demand results in increased supply and vice versa, with scientists and manufacturers vying with each other to introduce new and enhanced procedures and their facilitating technologies at ever lower cost. For such reasons sensitivity concerning appearance is now a global phenomenon. People watch their favourite stars and famous people undergo cosmetic changes to their appearance and, due to the power of television, the internet and social media, they are becoming increasingly aware of just what is possible.
According to Dr Rezai, the most commonly requested surgical procedures in the UAE are Rhinoplasty (nose reshaping surgery), various types of breast surgery and body contouring procedures. Male chest reduction for those suffering from gynecomastia is also very much on the increase following a greater public awareness of the surgical solution for this problem.
Social pressure combined with a sometimes idealised and unrealistic expectation of what is possible, combined with a growing awareness of the potential affordability of Cosmetic Surgery to a wider sector of the populace has also lead people to seek both surgical an non-surgical solutions at an increasingly younger age. And this has been exacerbated by certain unscrupulous clinics and practitioners in various parts of the world actually marketing to the fears and desires of susceptible individuals rather than to their real needs.
To avoid problems such as this, a reputable and responsible Cosmetic Surgery practice will typically provide clear advice and guidance to potential patients prior to accepting to undertake a surgical procedure. Dr Rezai explains that “There have been times when patients have come to us without any genuine necessity for the surgery they are requesting. Many look into the mirror and see what they really want to see. I provide a very lengthy and thorough consultation where I closely question the patient and look for any underlying psychological problems. If I detect any such issues, I always direct the patient to a psychologist for counselling. For instance, a little while ago, I had a middle-aged woman who came in for a breast enlargement procedure. During Consultation, I realised that she was suffering from psychological trauma following divorce. Her husband had left her for a younger woman. I advised her to undergo counselling and wait for a year before this surgery. She followed the advice and returned to me after a year. This time, following an in-depth consultation, I was convinced that she was undergoing the surgery not because of any other psychological trigger or trauma, I agreed. She has since become more calm, confident and happy following the surgery. That one step alone has changed her temperament and confidence. However, sometimes when we advise a patient to undergo counselling, the chances are that they will find an unscrupulous surgeon somewhere who will be willing to help them quickly without proper evaluation. For this reason it is absolutely vital for a patient to see at least two or three surgeons prior to making up his or her mind to undergo surgery.”
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Fortunately, plastic and cosmetic surgeons usually have high standards of ethics and a deep sense of responsibility. That is why, according to Dr Rezai, in most clinics patients are asked to complete a detailed questionnaire before their consultation, and will also have to undergo a lengthy consultation session with their surgeon. Dr Rezai likes to see his patients at least twice prior to surgery to make sure they understand its importance and are fully conscious of their decision to undergo surgery. He will always reject any patient who is not totally suitable for surgery or has an unrealistic expectation of the outcome.
In the consultation Dr Rezai’s object is always to arrive at a mutual understanding. “I really try to understand why the patient is wanting to undergo the surgery,” says Dr Rezai. “I explain to them the procedure, the indications for surgery, and the pros and cons of surgery, and then I ask them to go home and reflect on what we discussed during consultation and then come back to see me for a second consultation. I make a decision on a case-by-case basis and the principles of plastic surgery. If the patient has an indication for surgery and realistic expectations then I will proceed, if not I decline the patient with an explanation as to why. Most patients understand and appreciate this.
By way of example, Dr Rezai provides some details relating to the Facelift procedure, the indications for which, according to the doctor, are an excess of skin, sagging skin, a break in the jaw line, a jowly appearance, lost volume in the face, and increasing visibility of laughter lines. “If a patient has these criteria,” declares Dr Rezai, “then he or she is a good candidate for Facelift surgery. I absolutely do not accept a patient below 40 years of age who does not have the above signs but would like to undergo this procedure. They may, however, try non-surgical or non-invasive treatments instead of surgery. Recently I had a woman of approximately 56 years who came in for a Facelift procedure. Her reasons were valid. She had loose skin hanging from her jowls; the laughter lines were prominent; and she had lost volume from her cheeks. The Facelift could definitely help take ten years off the apparent age of her face and she was a deserving candidate. In such cases surgery can really help. She also agreed with me that surgery cannot stop the ageing process but it can prolong it with grace.”
Unfortunately not all people are aware of the risks of Cosmetic Surgery, considering it to be a quite minor procedure and, instead of opting for the safer option, they choose to go with whoever offers a cheaper price, overlooking the implications involved. However all potential patients should be aware that Cosmetic Surgery is not risk-free, and carries the same general risks and complications as all surgery. These include wound infection, bleeding, blood clots, healing issues and scarring, although these are rarely life-threatening or long-term. There are also specific risks associated with every procedure and these should be thoroughly discussed during consultation with the surgeon. To reduce the risks and possible complications, in addition to choosing a qualified surgeon, it is of utmost importance that a patient's medical history is checked for any contraindications, in addition to undergoing any necessary pre-operative tests relevant to each procedure prior to surgery.
In terms of risk, it can generally be stated that the procedures taking longest to perform carry the greatest amount of risk. Procedures such as Abdominoplasty (tummy tuck) and Full Facelift, for example, take longer and thus the patient will be under general anaesthetic for a longer period of time. But as long as there are the right indications for surgery and it is performed by a qualified surgeon at a well-equipped hospital there should not be any additional risks and complications associated with Cosmetic Surgery beyond those commonly associated with any type of surgery.
It is generally agreed that Cosmetic Surgery has the power to help a person undergo a life-changing experience. Indeed, statistics indicate that over 95 per cent of patients who elect to have cosmetic procedures return home highly satisfied and with a heightened sense of self-esteem. However, according to Dr Rezai, in some limited cases, Cosmetic Surgery has the potential to cause a negative effect on a patient. These tend to be cases where a patient has underlying psychological problems which he or she may not be addressing, or indeed of which they are totally unaware. In such circumstances surgery can cause a change that the patient is not mentally prepared to face and it could trigger a conflict deep down within their mind. In such cases people are advised to first address the main and larger issues and to desist from going under the knife as a sort of quick-fix solution.
As to what can go wrong with Cosmetic Surgery, the media is full of sensationalised examples and, according to Dr Rezai, there are countless possibilities. Worldwide there have been cases of botched Cosmetic Surgery procedures ranging from Liposuction to breast surgery and Facelift. For this reason it is important that the patient checks the qualifications of a surgeon; makes sure that they have sufficient experience; and also considers other factors such as the medical facility where the surgeon performs the operation, and of course the post-operative care that the surgeon offers. The latter factor is a very important consideration when choosing a plastic surgeon and will often highlight the difference between a good surgeon and a bad one. An experienced surgeon with a solid track-record is unlikely to hesitate in offering equally first rate after-care.
Another question somewhat allied to the latter of what can go wrong, is the issue of patients needing to return for repeat surgeries. Dr Rezai explains that “Worldwide the rate of patients who come in for repeat surgeries is high. This is because the results of certain surgeries have a defined life span. For instance in the case of Facelifts, the life span is 5-7 years. Perhaps ten years later the patient will come for a repeat Facelift. The same might equally apply to eyelid surgery once the effect of the original surgery has worn off. However, revision surgery is different from repeat surgery. Revision is mainly done to improve the results following the initial surgery. Despite the efficacy and skill of plastic surgeons, globally the level is in the range 3-5% for breast surgery and 5-10 % for Rhinoplasty - nose reshaping.”
For most people considering Cosmetic Surgery, price is obviously one consideration that must be taken into account. And indeed it is only human nature that a little cost-benefit analysis will be performed, if only subconsciously, when deciding whether to undertake elective Cosmetic Surgery. Unfortunately this is an area where in many cases it is difficult to be precise in advance of a consultation with a surgeon when an individual's needs will be firmly established. Certainly in the case of surgical procedures. However, according to Dr Rezai, prices can range from AED 600 for a non-invasive procedure to upwards of AED 80,000 for a complicated invasive procedure.
One question that tends to be asked with increasing frequency in today's economic climate is whether or not a clinic is able to offer some form of finance scheme to ease the burden of payment. And this is an area in which Dr Rezai has a clear and unequivocal opinion and message: “In my own practices, both at Harley Street, London, and Elite Plastic & Cosmetic Surgery Group in Dubai, the policy is that we are absolutely against any kind of instalment scheme for Cosmetic Surgery. I feel that if a person cannot afford cosmetic surgery then he or she must absolutely desist from it. That is why we do not encourage any kind of finance schemes for Cosmetic Surgery procedures. I believe it to be totally unethical for surgeons to allow those who cannot afford a cosmetic procedure to go under the knife. In the West, the instalment scheme is a proposition that attracts the very young generation to the surgeon’s table. Although I believe that everyone has a right to Cosmetic Surgery, and the right to look the way they want, I also believe that it is important for the person to be able to save that sum to elect for the surgery, thus making it the result of a more conscious and deliberate decision following a period of thought, as opposed to being the result of a whim and the need for instant gratification. After all, Cosmetic Surgery can and does produce life-changing results and should thus be taken very seriously.”
To conclude, we asked Dr Rezai to provide a list of what he believes to be the most important considerations to be taken into account when contemplating Cosmetic Surgery and choosing a surgeon. The following was his reply in the form of a simple but comprehensive check-list:
- Think about the change you want to see, then research and find out as much information as possible about the treatment, being precise about what you want and, above all, be open to all your wishes not being achievable.
- Find a qualified plastic surgeon experienced in the desired procedure, making sure that he or she is board certified. Also look for “genuine” reviews and feedback from previous patients.
- Have consultations with at least 2 or 3 qualified and experienced surgeons, just to have something to compare and cross-check.
- Be honest about your medical history and discuss all aspects of the surgery with the plastic surgeon. Do not be afraid to ask questions, since it is important to know the risks involved and feel comfortable with the person who will be carrying out the surgery. The plastic surgeon should be able to explain why they recommend a certain type of treatment option or technique, as with all cosmetic surgery, the type of technique used depends on many factors involving the patient’s indication for treatment, anatomy and lifestyle, and a treatment plan should be tailored to suit the specific needs of the patient.
- Find out what type of care is offered before, during, and especially after the surgery as after-care can be just as important as the surgery itself. So make sure you know who to contact and how you will be looked after, especially if there are any complications or problems following your surgery. Also find out where the surgery will be performed, as this can have major implications on safety during the operation and the occurrence of possible risks and complications.
- Last but not least, “COOL OFF” before you commit. Cosmetic Surgery should not be taken lightly, as it is after all a surgery. Take your time and reflect on all aspects of the procedure, and make sure you understand all the implications involved before you make an informed decision to proceed.
Dr Allen Rezai is a Consultant Plastic and Reconstructive Surgeon with clinics in Harley Street, London, UK and at Elite Plastic & Cosmetic Surgery Group in Dubai Healthcare City, UAE.