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Cosmetic Surgery: An Overview Cosmetic surgery refers to any surgical procedure that is performed primarily in order to improve or enhance a patient's physical appearance. It is sometimes known as "plastic surgery." Cosmetic procedures are thus those treatments that are not otherwise required for reasons of medical necessity. Cosmetic surgery should not be confused with reconstructive surgery, which may result in overall improvements to a patient's appearance. The primary purpose of reconstructive surgery is to repair the function of a damaged or abnormal body structure and the associated. Common types of cosmetic surgery include breast augmentation, liposuction, rhinoplasty (surgery on the nose), tummy tucks, facelifts, dermabrasion (the removal of marks and blemishes), and eyelid surgery. Other popular cosmetic procedures are less invasive, such as laser hair removal, injections to remove wrinkles and frown lines, and chemical peels to improve skin texture. There is a huge and growing consumer demand for various types of cosmetic procedures in the United States. According to figures published by the American Society of Plastic Surgeons, Americans spent $11.5 billion on a total of 11 million cosmetic procedures in 2006 alone; since 2000, the number of cosmetic procedures has increased by 48 percent. Proponents see this kind of surgery as a simple, potentially life-altering means of improving self-esteem and addressing feelings of shame or discomfort over a perceived physical flaw. For example, individuals diagnosed with Body Dysmorphic Disorder (BDD), a documented behavioral diagnosis in the DSM IV (categorical classification system of diagnosis used for statistical tracking and billing), are candidates for psychiatric intervention, yet may be attracted to cosmetic correction, particularly when this psychiatric disorder has led to quality of life costs. Others consider cosmetic surgery nothing more than a reflection of unnecessary vanity and a disturbing symptom of society's unhealthy obsession with the pursuit of beauty and perfection. In recent years, controversy has also sprung up over the safety of various cosmetic procedures, which have ironically left some patients scarred, in pain, or suffering serious health risks. Understanding the Discussion Dermabrasion: A procedure in which the upper layers of the skin are worn away ("abraded") either by mechanical or chemical means, to reveal the younger skin cells below. Medically, dermabrasion is a therapeutic intervention to mitigate appearance of surgical or traumatic scars, to remove benign tumors, or to remove superficial skin cancers. Risk factors, although rare, do exist, such as post-operative infection at the site or worsened acne as a result of occlusive wound dressings. Facelift: A surgical procedure that removes excess skin from the face and chin, tightens the skin that remains and results in a more youthful appearance. Liposuction: A surgical procedure in which fatty tissues are broken up and sucked out of particular parts of the body-usually the legs, buttocks, or abdomen-with a specialized vacuum. Reconstructive Surgery: Surgery that reshapes or repairs a part of the body that has been damaged by illness, trauma, birth abnormalities, or previous medical treatment. Rhinoplasty: A surgical procedure that alters the size or shape of the bridge or tip of the nose. History The earliest known historical records of cosmetic surgical procedures date back almost 4,000 years, to the ancient civilizations of India and Egypt. A handbook written by an Indian surgeon sometime between 600 and 400 BCE, for example, describes a technique in which a piece of skin from the patient's cheek can be used to reconstruct his or her nose or earlobe, and various Egyptian writings detail surgeries that were designed to repair damaged bones in the nose or jaw. Such methods were also used by Greek and Roman physicians through the Byzantine period and into the Middle Ages. Over time, new techniques, such as a simple method for repairing cleft lips and an early form of eyelid surgery, were developed. However, significant improvements in the field happened extremely slowly, if at all, and procedures were generally confined to repairing damage from illness or trauma, rather than being performed for aesthetic reasons. This was largely due to the lack of sanitary surgical environments and the resulting fact that any invasive procedure left patients enormously susceptible to infection. Beginning in the late eighteenth century, the establishment of antiseptic standards in surgery and the almost simultaneous discovery of anesthesia made surgical procedures of all kinds much safer and more tolerable for patients. These improvements in medical technology allowed surgeons to perform increasingly elaborate procedures, and in the nineteenth century, the first true cosmetic surgeries, including breast augmentations and rhinoplasties, were performed. One notable case involved the 1896 reconstruction of a young boy's oversized ears, which jutted out from his head and caused him great embarrassment. At the time, the procedure was considered extremely radical and somewhat frivolous, and as a result the German doctor who performed the surgery, Jacques Joseph, was dismissed from his position at a clinic. Joseph went on to invent a number of influential techniques in cosmetic surgery, and is now remembered as an important pioneer in the field. In summation, the acceptance of plastic surgery as a recognized subspecialty in medicine was slow to develop but in today's culture it has been embraced; surgical residencies and fellowships in recognized academic institutions hold sought-after slots for hopeful surgical medical students. In the twentieth century, the battlefields of two world wars proved to be fertile ground for the development of new techniques in cosmetic surgery. Physicians were forced to repair faces and bodies that had been severely damaged by modern weaponry and allow badly injured soldiers to return to their daily lives, find work, and rejoin their families and communities. As the century wore on, these innovative techniques slowly began to transfer into mainstream surgery, and the notion of undergoing a surgical procedure for cosmetic purposes alone became more and more acceptable. In 1921, a group of practicing cosmetic surgeons formed the first specialty organization of its kind, the American Association of Oral and Plastic Surgeons, which became the American Association of Plastic Surgeons in 1941. Other professional organizations of surgeons in the field were established during the same period, such as the American Society of Plastic and Reconstructive Surgeons, in 1931, and the American Board of Plastic Surgery, in 1937. Today, cosmetic surgery is so much a part of American culture that it no longer carries a negative stigma; procedures like face lifts, tummy tucks, rhinoplasties, lip augmentations, and dermabrasion are performed on millions of people each year. Affordability and the fact that most insurers will not pay for cosmetic surgery can lead to the perception that consumers of these services are a limited class of economically advantaged or those who are willing to financially leverage themselves for aesthetics' sake. Cosmetic surgery is sometimes identified with a form of Boutique Medicine: desired services paid for fully by the consumer without benefit of third party reimbursement. There is the possibility of exception if the surgeon can defend the cosmetic surgery as being medically therapeutic to the payer. Some doctors and consumers who believe in the positive benefits of cosmetic surgery point to the powerful psychological impact such operations can have on those who undergo them, and argue that the state of current medical technology makes most cosmetic procedures increasingly safe and effective. Proponents argue that a preoccupation with physical imperfections, even if such characteristics are relatively minor, causes poor self-esteem and erodes confidence levels in many people. According to its supporters, cosmetic surgery can result in genuine improvements in quality of life and happiness. Critics of cosmetic surgery, on the other hand, claim that the growing popularity of these procedures reflects a quest for an impossible ideal of beauty and a fixation on preserving signs of youth at all costs. Many who receive cosmetic surgery, opponents say, will never be satisfied with their physical appearance, and are only harmed by the superficial notion that enhanced physical beauty will lead to greater joy or a renewed sense of self. The operations can also be dangerous, they claim, pointing to the furor over a series of ruptured silicone breast implants in the 1990s and the increasing number of people who find themselves suffering sometimes life-threatening complications after traveling abroad to have cosmetic surgery at a cheaper price. Still, the many Americans who are willing to accept these risks and bear the costs of cosmetic surgery suggest that for many, physical enhancement is a prize worth its price. Psychiatry professionals have suggested that the desire for extreme perfectionism will increase consumers' likelihood of seeking invasive cosmetic procedures going forward. The nation's financial crisis this year is already having an impact on consumers' behavior and will likely decrease demand for such services until the economy corrects. Cosmetic Surgery Today The early years of the twenty-first century have seen the rise of a new phenomenon known as "extreme plastic surgery," in which patients-usually women-choose to undergo multiple surgical procedures at the same time, in an attempt to radically remake their physical appearances. This practice has been driven in large part by the appearance of reality television programs which chronicle such transformations and present them as life-changing improvements. Although few studies evaluating outcomes resulting from multiple procedures are available, one such evaluation reported in Plastic and Reconstructive Surgery found no statistically significant increase in complications when abdominoplasty and elective breast surgery were performed in the same session. Other current trends in cosmetic surgery include parties where every guest receives injections designed to temporarily paralyze their facial muscles (thus reducing wrinkles, laugh lines, and frown lines), and so-called "cosmetic surgery tourism," in which people purchase complete vacation packages at exotic locations that have, included in their price, a set of personalized surgical procedures. Biodegradable injectable products to improve the appearance of facial mass lost with age are less invasive than a surgical procedure and are gaining popularity with aging baby-boomers. These 'skin fillers' include botulinum toxin, commonly known as Botox. Therapeutically, (as opposed to electively cosmetic), Botox has been used successfully to reduce muscle spasticity associated with specific neurological disorders. Among the top cosmetic surgery procedures performed in the United States in 2006 were rhinoplasty, breast augmentation, and tummy tucks. In 2007, eyelid surgery and breast reduction were added to the growing list. Bibliography Books Haiken, Elizabeth. "Venus Envy: A History of Cosmetic Surgery." Baltimore: Johns Hopkins University Press, 1997. Panfilov, Dimitrije E., translated by Grahame Larkin. "Cosmetic Surgery Today." New York: Thieme, 2005. St. John, Jeff, and George Semel. "The Complete Idiot's Guide to Cosmetic Surgery." Indianapolis, IN: Alpha Books, 2001. Sullivan, Deborah A. "Cosmetic Surgery: The Cutting Edge of Commercial Medicine in America." New Brunswick, NJ: Rutgers University Press, 2001. Periodicals Bayer, Kathryn. "Cosmetic Surgery and Cosmetics: Redefining the Appearance of Age." Generations 29.3 (Fall2005 2005): 13-18. Academic Search Premier. EBSCO. 18 June 2009 <http://search.ebscohost.com/login.aspx?direct=true%26db=aph%26AN=19399877%2 6site=ehost-live>. Cooper, Leah Beth. "Nursing Students' Perceptions of Clients Undergoing Elective Cosmetic Surgery." Plastic Surgical Nursing27.3 (July 2007): 158-162. Academic Search Premier. EBSCO. 18 June 2009 <http://search.ebscohost.com/login.aspx?direct=true%26db=aph%26AN=27253315%2 6site=ehost-live>. Dolsky, Richard L. "Cosmetic Surgery in the United States: Its Past and Present." Dermatologic Surgery 25.11 (Nov. 1999): 886-892. Academic Search Premier. EBSCO. 18 June 2009 <http://search.ebscohost.com/login.aspx?direct=true%26db=aph%26AN=5187128%26s ite=ehost-live>. Gimlin, Debra. "Cosmetic Surgery: Beauty as Commodity." Qualitative Sociology 23.1 (Mar. 2000): 77-98. Academic Search Premier. EBSCO. 18 June 2009 <http://search.ebscohost.com/login.aspx?direct=true%26db=aph%26AN=11302676%2 6site=ehost-live>. Markey, A. C. "Dermatologists and cosmetic surgery- a personal view of regulation and training issues." Clinical & Experimental Dermatology 29.6 (Nov. 2004): 690-692. Academic Search Premier. EBSCO. 18 June 2009 <http://search.ebscohost.com/login.aspx?direct=true%26db=aph%26AN=15091430%2 6site=ehost-live>. Meisler, Jodi Godfrey. "Conversation with the Experts: Toward Optimal Health: The Experts Discuss Cosmetic Surgery."Journal of Women's Health & Gender-Based Medicine 9.1 (Jan. 2000): 13-18. Academic Search Premier. EBSCO. 18 June 2009 <http://search.ebscohost.com/login.aspx?direct=true%26db=aph%26AN=5323766%26s ite=ehost-live>. Morgan, Kathryn Pauly. "Women and the Knife: Cosmetic Surgery and the Colonization of Women's Bodies ." Hypatia 6.3 (Fall91 1991): 25-53. Academic Search Premier. EBSCO. 18 June 2009 <http://search.ebscohost.com/login.aspx?direct=true%26db=aph%26AN=9201061260 %26site=ehost-live>. Sharma, Vijay. "Changing Faces: Patient Information on Cosmetic Surgery Part 1." International Journal of Cosmetic Surgery & Aesthetic Dermatology 4.4 (Dec. 2002): 269- 278. Academic Search Premier. EBSCO. 18 June 2009 <http://search.ebscohost.com/login.aspx?direct=true%26db=aph%26AN=9319892%26s ite=ehost-live>. Sherry, S.B. et al. "Perfectionism and Undergoing Cosmetic Surgery." European Journal of Plastic Surgery 29:8. (May, 2007). 349-354. Shute, Nancy. "Makeover Nation. (Cover story)." U.S. News & World Report 136.19 (31 May 2004): 52-63. Academic Search Premier. EBSCO. 18 June 2009 <http://search.ebscohost.com/login.aspx?direct=true%26db=aph%26AN=13192905%2 6site=ehost-live>. Stevens, W. Grant, et al. Is It Safe to Combine Abdominoplasty with Elective Breast Surgery? A Review of 151 Consecutive Cases. Plastic and Reconstructive Surgery118:1. (July, 2006). 207-212. Veale, David. "Body Dysmorphic Disorder". Postgraduate Medicine Journal: 80. (2004) 67-71. Wein, Bibi. "The Changing Face of Cosmetic Surgery." Biography 6.7 (July 2002): 62. Academic Search Premier. EBSCO. 18 June 2009 <http://search.ebscohost.com/login.aspx?direct=true%26db=aph%26AN=6824529%26s ite=ehost-live>. Yoho, Robert A., Jeremy J. Romaine, and Deborah O'Neil. "Review of the Liposuction, Abdominoplasty, and Face-Lift Mortality and Morbidity Risk Literature." Dermatologic Surgery 31.7p1 (July 2005): 733-743. Academic Search Premier. EBSCO. 18 June 2009 <http://search.ebscohost.com/login.aspx?direct=true%26db=aph%26AN=17610570%2 6site=ehost-live>. Websites American Society of Plastic Surgeons. "2006 Quick Facts: Cosmetic and Reconstructive Plastic Surgery Trends." <http://www.plasticsurgery.org/media/statistics/loader.cfm?url=/commonspot/security/g etfile.cfm%26PageID=23625>. Mayo Clinic. "Cosmetic Surgery: What to Know Beforehand." August 11, 2006. <http://www.mayoclinic.com/print/cosmetic-surgery/SN00006/METHOD=print>. These essays and any opinions, information or representations contained therein are the creation of the particular author and do not necessarily reflect the opinion of EBSCO Publishing. ~~~~~~~~ By M. Lee Co-Author: Nancy Sprague Nancy Sprague holds a BS degree from the University of New Hampshire and a Masters Degree in Health Policy from Dartmouth College's Center for the Evaluative and Clinical Sciences. Nancy began her career in health care as a registered nurse and certified finance and coding specialist. Since earning her undergraduate degree in Business and graduate degree (MS) in Health Policy, Nancy has worked in private medical practice, home health, consulting, and most currently as Director of Ambulatory Operations for a large Academic Medical Center. Her operational experience as a nurse and business manager in private medical practice and for the last decade in a tertiary medical center have allowed Nancy rich insight into health care, clinic administration, human resources and research. She is a Fellow in the American College of Medical Practice Executives. Copyright of Points of View: Cosmetic Surgery is the property of Great Neck Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
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