Thursday 9 July 2009

Extreme Cosmetic Makeovers - Good or Bad Idea?

Many of us have watched at least one episode of one of the
latest reality TV shows about extreme cosmetic makeovers.
Admit it; it's mesmerizing to watch someone with
significant physical flaws be transformed into a younger,
more attractive version of themselves. Many people seem to
undergo a personality makeover as well, gaining confidence
and discovering a more gregarious and outgoing nature than
before. Having indulged our curiosity or stoked our own
thoughts of how we'd like to be made over, people seem to
come away with either of two vastly different points of

"What a gift! It's so exciting that this person has the
opportunity to overcome appearance issues that have
hampered their quality of life. Inspiring to see their
dream of a new image come true. Good for them or
maybe...wish it were me." OR "What are these people
thinking? How can they subject themselves to the pain and
surgical risk over image concerns? Extreme makeover just
feeds into our society's increasingly impossible standards
for personal appearance."

These polar opposite positions raise serious questions. Is
extreme makeover surgery too great a risk for too little
reason? Or is it a medical achievement that offers people
who suffer with physical problems a new lease on life? As
you might expect, the answers to these questions are not

Cosmetic procedures are growing at a staggering rate
worldwide and in the U.S. Even though most cosmetic
surgeries and non-surgical procedures are not covered by
insurance, more and more people are taking advantage of the
growing range of treatments for appearance flaws,
especially related to aging. In 2007, over 11.7 million
cosmetic procedures were done, a 446% increase over 1997!

The top cosmetic surgical procedures in 2008 were breast
augmentation, nose reshaping, liposuction, eyelid surgery
and tummy tuck whereas the top 5 non invasive procedures
were botox, hyaluronic acid, chemical peel, laser hair
removal and microdermabrasion.

Cosmetic procedures are one thing; extreme makeovers are
really a special subset of the cosmetic surgery field. An
extreme makeover is defined as undergoing more than one
cosmetic surgical procedure at the same time. The
popularity of extreme cosmetic makeover reality TV shows is
another overwhelming indicator of Americans' desire for a
physical overhaul. Ten thousand applicants tried for a spot
on Extreme Makeover's second season.

However, the controversy over extreme makeovers was brought
into focus over the tragic death of Donda West. Ms. West
was 5 feet 2 inches tall, weighed 188 pounds and had a
history of high blood pressure, high blood sugar and
cardiac artery blockage. The procedures performed on Ms.
West included liposuction, partial breast reduction, two
breast implants, belt lipectomy (removal of fat around the
waist and skin tightening), and abdominal muscle tightening.

Despite information suggesting that extreme makeovers will
become increasingly more common, there are many
controversial issues under discussion regarding extreme
makeover surgery.

(1) Anesthesia Risk in Prolonged Surgeries. Anesthesia has
a strong effect on the cardiovascular system. Prolonged
anesthesia can create a greater risk of complications such
as pulmonary thrombosis, where blood clots form in the
veins and enter the lungs and the prolonged anesthesia
usually means a longer recovery period. Although there have
been few studies done on the effects of long periods of
anesthesia, physicians generally agree that more than six
hours of anesthesia should be avoided if possible. Extreme
makeovers can last well over six hours, depending on the
number of procedures being done.

However, plastic surgeons who perform extreme makeover
surgery suggest that it is preferable for the patient to
undergo one episode of anesthesia than three or more
separate episodes and that the recovery period for one
session of extended anesthesia is much shorter than the
combined recovery periods from multiple surgeries performed
at different times.

(2) Surgical Complications. Cosmetic surgery, like any
surgery, includes some risk of complications. In
particular, cosmetic surgery risks include asymmetries,
dimpling, loss of sensation, tingling caused by nerve
damage, fluid collection under the skin (seroma), infection
leading to skin death. When multiple surgeries are
performed at once, the risk of complications multiplies at
the same time that the body's immune system is assaulted by
the invasive procedures.

However, overall plastic surgery risks are relatively
small. The risk of serious complications is less than half
of one percent. Mortality plastic surgery risks affect only
one in 57,000 patients. Plastic surgery risks are the
lowest when the procedure is performed in an appropriate
environment (hospital or surgery medical office) by a
surgeon certified by the American Board of Plastic Surgery.

Other physicians suggest, however, that there is value in
performing one procedure at a time, evaluating the results
and making adjustments in subsequent procedures. Plus,
multiple procedures multiplies the risks while reducing the
body's ability to fight.

(3) Quick Fix versus Better Choices. Some people worry that
extreme makeover surgery, especially surgeries including
liposuction and other procedures for fat removal and body
tightening, provide an unrealistic quick fix that not only
exposes people to unnecessary surgical risks but does not
address the underlying issues of need for weight control
and exercise.

Others argue that most physicians recommend appropriate
lifestyle changes to support these types of surgeries and
that some people need to begin with the success of the
procedure to develop the motivation to truly adopt a
different lifestyle.

(4) Promotion of Unrealistic Ideals of Beauty. In an
article about teenage girls, Susan Carney writes that, "The
concept of "normal" has become so skewed that it is
difficult for most girls, and often for the rest of us, to
see things in their proper perspective. Healthy bodies come
in a wide range of shapes and sizes. However, we have been
conditioned to accept only a very narrow definition of
attractive and to consider abnormal almost everything that
does not meet those impossible standards".

Moreover, there is a psychiatric disorder, body dysmorphic
disorder (BDD), that causes people to believe that they
have physical flaws which must be corrected, whether that
is realistic or not. People suffering from BDD can become
cosmetic surgery addicts.

On the other hand, proponents argue that extreme makeover
surgery gives people a new lease on life, allowing them to
be the best that they can be, encouraging self-confidence
and in some cases, leading to better diets and more
exercise. They further argue that plastic surgeons are well
aware of BDD and know how to screen patients for signs of
this disorder.

(5) Cosmetic surgery gifts and prizes remove selection
safeguards. While plastic surgery professional groups have
been positive about some reality extreme cosmetic makeover
programs because they raise awareness and provide
education, the same groups are opposed to contests where a
person receives the opportunity for a makeover as prize.
Physicians say that it is critical that a qualified
specialist determine whether or not a patient should
undergo a procedure; faced with a patient who has won a
makeover prize, a physician may be hesitant to reject the
person as a candidate even if that's the right decision.

Whether you agree about the worth of extreme cosmetic
makeover or not, the combined procedures approach does
increase the risks of complications due to anesthesia or
surgery but there is no clear evidence at this point that
those risks are too great to consider going forward.

However, differing opinions about the value of and the need
for extreme makeovers aside, there is one underlying theme
that runs through all of the discussion on this topic - it
is absolutely critical that the doctor who performs any
procedure be qualified to do so. The data show that a
skilled, experienced physician must evaluate the patient's
current medical condition to confirm that they are a
candidate for an episode of extended surgeries, evaluate
the patient's requests to be sure that they are reasonable,
that expectations are not unrealistic and that the patient
is not suffering from a mental disorder that should be
treated by a therapist rather than a plastic surgeon and
educate the patient about risks and benefits for informed
decision making.

One of the best ways to evaluate a physician's competence
is to be certain that he or she is certified by the
American Board of Plastic Surgery, the only plastic surgery
board recognized by the American Medical Association. Even
if your procedure will be done outside the hospital
setting, check to be certain that your doctor has some type
of hospital privileges, often courtesy privileges.
Hospitals have stringent credentialing processes; their
approval is an excellent safeguard.

If your procedure will be performed in non-hospital
setting, ask if the facility is accredited by the Joint
Commission on the Accreditation of Healthcare Facilities
(JCAHO) or the American Association for the Accreditation
of Ambulatory Surgery (AAAASF). Ask if an anesthesiologist
will be available for any complications.

Extreme cosmetic makeover remains popular but somewhat
controversial. If you decide to consider it, follow good
consumer decision making practices to be sure that your
experience is as safe as possible.

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