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
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
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
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
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.
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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
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.
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