FEATURE:

It’s not all nip and tuck for plastic surgery anymore

Are you itching to correct age spots, wrinkles, varicose veins, crow’s feet, a double chin, bags under your eyes, frown lines in your forehead, deep crevices from nose to mouth, loose jowls, sagging breasts or flabby arms, all those imprints that make you look older than you want to?

Increasingly, there are new options for those seeking to turn back the lines of time.

Technology in cosmetic surgery has advanced so much that “going under the knife” today more often means “going under the laser.”

“There are a lot of treatments that can be done in the office with no downtime,” said Dr. Gregory J. Herbich, who runs the Cosmetic & Laser Surgery Center in downtown Honolulu.

Among rejuvenating techniques in the doctors’ arsenal are heat, ultrasonic and radio frequency treatments, and the injection of collagen and other fillers to flesh out wrinkled or sagging skin, especially in the face. Surgeons also can rejuvenate hands, which often become bony and wrinkled with age.

The litany of chemical filler products — Botox, Retylane, Juviderm, Radiesse, Sculptra, Artefill — staggers the uninitiated mind.

Other tools available to local cosmetic surgeons include Thermage, which uses a special radio frequency to heat the dermal layers. The process can tighten the skin or reduce scars while a cooling spray is applied to prevent burns. Skin continues to tighten for up to six months after the procedure.

Surgeons can remove fat (through liposuction) from one part of your own body, such as thighs, buttocks or abdomen, clean it, process it, and inject it into your face or elsewhere to fill out wrinkles. Fat grafting, also called free fat transfer, (FFT), is not new, but has taken years to develop and be accepted, according to surgeons.

The advantage of FFT in many cases, surgeons say, is that using the patient’s own body tissue avoids allergic reactions, infections and other dangers caused by introducing foreign substances to the body. Surgeons can even “harvest” extra fat from your body through liposuction, freeze it and store it to use for later treatments.

It should be noted that these procedures may not work well in all situations, and as with all surgical procedures, there is some risk involved.

Before and after photos show results of chin lift.

How well do these procedures work in comparison with traditional surgery methods?

Most surgeons say frankly that it’s a trade-off. Results can be very good, but are usually less dramatic and less permanent than traditional surgery. Fillers may have to be redone in three to six months or a year, as the body absorbs them. “Some of these treatments can do only so much,” warns Dr. Clyde H. Ishii, chief of plastic surgery at Shriners’ Hospital for Children in Honolulu and former chief of plastic surgery at The Queen’s Medical Center.

“Cutting still gets the best result,” notes Dr. Robert L. Peterson, who heads Athena Clinic on Kapiolani Boulevard, and is chief of plastic surgery at Kapiolani Medical Center for Women and Children, “but a lot of people are willing to compromise to have less recovery time. Also, if the results are less dramatic, you don’t get reactions like, ‘My God, what did you have done?’ You want the results to look natural.”

There are limitations to non-surgical procedures. If skin has lost too much elasticity fillers may not be adequate and excess skin has to be cut out. “We keep trying to come up with ways to tighten the skin without removing it,” says Dr. Gregory G. Caputy, chief surgeon at Aesthetic Plastic & Laser Surgery Center in Honolulu.

This before and after photo shows how forehead lift can remove wrinkles.

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Sometimes other techniques are combined with surgery to get the best result. Still, the trend is away from the scalpel. As Dr. Herbich points out, “As much as 80 percent of our work is non-surgical.”

Reasonable expectations have a lot to do with the business of plastic surgery, and always have. If you are 60, doctors agree, the most skilled surgeon in the world can’t make you look 30 again, just a better 60.

Caputy says most of his older patients have reasonable expectations. “Many of them have one feature that’s bugged them and finally want to do something about it. They don’t want to look 20, they just want to correct a flaw and feel better about themselves. But you get a few who expect the witness relocation special. I spend a fair amount of time talking people out of things.”

The most common procedures for the over-50 group in Hawai‘i?

Not surprisingly, treatment related to sun damage, including wrinkles and melasma (brown age spots) is high here compared to other states except Florida and California.

Puffy eyes, above, are corrected by cosmetic surgery in this before and after photo.

Liposuction or body sculpting is popular. This is not a cure for obesity, surgeons say; it’s effective on a person of normal weight who has stubborn pockets of fat in a certain area that don’t respond to diet and exercise.

Eyelid surgery to lift sagging upper lids and/or reduce bags under the eyes can make one look younger, fresher and less tired.

Botox and other injections smooth out wrinkles and folds.

Full or mini facelifts, forehead lifts and other “knife” procedures are surgical big guns. A facelift usually refers to the lower part of the face, lifting a sagging chin, getting rid of nasal-labial folds, resculpting the cheeks, repositioning muscle tissue. It may or may not involve the neck. A forehead lift can reduce frown lines and an angry, unhappy look to the upper face.

For older women, breast lifts or reductions are popular. Seniors don’t seek breast augmentation that often, except that small implants may be used to provide lift. Surgeons are also doing breast lifts with Thermage.

Breast reduction is especially common in older women who had breast augmentation in their youth. Explains Caputy, “They are living with the results of operations they had when they were young and silly and wanted to be a DD. Now their breasts are sagging, their back is sore, the bra straps are cutting into their shoulders.”

Unfortunately, he adds, there is no way to do a breast reduction without some scarring from the nipples to the underside of the breast.

“We are getting better at making scars smaller but there is still a scar,” he notes. Caputy says he tries to talk young candidates for breast augmentation into the smallest size they can be happy with to avoid these future problems.

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Dr. Larry Schlesinger, who runs the Personal Image Center for Cosmetic Surgery of Hawaii, says men also look for breast reduction (called gynocomastia in men) because fatty breasts “don’t look masculine.” For men, liposuction to get rid of “love handles” and abdominal fat are common, as are hair transplants for baldness.

Both sexes seek treatment for varicose veins, age spots, bags under their eyes and sagging skin on the face.

Eyelid surgery is popular among Asian Americans, especially as sagging lids begin to create the look of sleepy slits to the eyes. The trend is away from creating folds that make Oriental eyes look Caucasian, though, surgeons say. Doctors prefer to shape lids to complement an Asian face.

Caucasians have more face lifts and have them sooner, according to Ishii, because Caucasian skin is thinner, fairer, dryer and more susceptible to sun damage. It ages faster than Asian, Polynesian or African skin.

Whatever you decide to have done, surgeons suggest that you learn as much as you can, consult with several surgeons, ask hard questions, and be assiduous about checking credentials. Nowadays, with so many non-surgical techniques available, there are clinics at which alternative procedures are performed by technicians, not surgeons.

“Do your homework,” says Dr. Schlesinger. “Consult board-certified surgeons and find out what they specialize in.”

To quote prices is tricky. In the health care field generally, prices are increasingly established by what health insurers are willing to pay. Cosmetic surgery is elective, and rarely covered by insurance, so fees can vary widely, not only from surgeon to surgeon, but from one patient to another, because everyone’s face and body is different, according to surgeons interviewed.

From ballpark price ranges mentioned to this writer by local surgeons and prices gleaned from various Web sites a full facelift can run a very broad range from $9,000 to as much as $25,000. At the low end of the spectrum, you may pay $20 to $40 per spot to have age spots zapped. In between, you can spend from $3,000 to $10,000 for a breast lift/augmentation; $4,000 to $6,000 or more for rhinoplasty (nose job); $3500 to $7,000 for a brow lift, up to $5,000 for eyelid surgery; $1,200 and more for fat grafting; $1,500 to $4,000 for dermabrasion; $2,000 and up for laser resurfacing; $350 to $400 for laser treatments for varicose veins; $600 to $850 for a chemical peel.
A caveat: The American Academy of Cosmetic Surgery warns that prospective patients should pay close attention to a surgeon’s qualifications, accreditation and track record, not just to price. Personal recommendations from friends and acquaintances are recommended, as is checking out any complaints against the practitioner. Surgeons who are exceptionally talented, experienced and well known can always command exceptionally high fees. But so can surgeons who are merely skilled at marketing themselves; they know that in some consumers’ minds, pricier implies better. The academy says that paying twice as much for an operation doesn’t guarantee you’ll get twice as good results.

But as Dr. Schlesinger notes, “I wouldn’t get a bargain basement surgery. The dangers are obvious. Do your homework. Make sure the surgeon is board certified, check out what he (she) is good at — we all have our specialties — ask to see before and after pictures, and make sure you have in writing exactly what is covered in the price.”

Dr. Peterson is concerned about cosmetic clinics that aren’t run by surgeons. “Look for credentials and experience,” he says. “If you go to a surgeon and surgery is ruled out, at least you know you don’t need it. But there are some non-surgical clinics out there that won’t tell you if you aren’t a good candidate for their treatments.”

Ishii adds, “Make sure the clinic has hospital accreditation and has hospital privileges.” He is concerned about people who take “surgical tours” to foreign countries, mainly in Asia and South America, where prices are cheaper.

It isn’t that there aren’t competent surgeons in these countries, but that recourse can be difficult if something goes wrong. “We monitor our patients for a year,” Ishii says. “If you go to Costa Rica or Brazil or Thailand you may stay a month. If you run into trouble later it’s not as easy to go back and get the problem corrected. Legally it’s a crap shoot. I wouldn’t recommend such a risky venture.”

Interviews with these Honolulu surgeons do not imply special endorsement or preference by GH. There are many qualified practitioners to choose from. This article should be used simply as a starting guide to your own research.

Kathy Titchen is a Honolulu freelance writer and a former reporter for the Honolulu Star-Bulletin=

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