ps not happy with TV image

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Plastic surgeons not happy with TV image

Abram Katz , Register Science Editor

10/12/2003

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The costs ofplastic surgeryWant to rearrange your face?Reshape that sagging stomach; renovate those thickening thighs; remove the bags under your eyes?And cram all of the surgery into a one-day medical marathon? You can — on television. Two shows, one network and the other cable, portray plastic surgery as a quick solution to life’s problems.Honest-to-goodness plastic surgeons say real procedures are slower, more uncomfortable, risky and not the answer to everything.No surgery should be taken lightly or with false expectations, they said.So much for the premise of both shows.Each episode of ABC’s "Extreme Makeover" takes two homely people who are operated on, coifed, made up, and designer-dressed, rendering them breathtaking and barely recognizable.That program oversells surgery as a panacea, but at least it’s built on a foundation of reality, doctors said.Not so show number two.FX offers the medical soap opera "Nip/Tuck," which follows the salacious exploits of two fictional plastic surgeons in Florida who mingle graphic surgery and sex."I’ve seen ‘Extreme Makeover’ twice and ‘Nip/Tuck’ once. I was not impressed," said Dr. Armand Simone, a Manhattan plastic surgeon."The reality they’re trying to present is all very deceptive. It’s such a tease it’s almost cruel," Simone said."People, if they can look better, they should. The shows mislead. Everything goes one, two, three. These surgeries are long arduous commitments. There’s recuperation and complications," he said.Despite the real-world discomforts and limitations, plastic surgeons do not lack patients.About 6.9 million cosmetic procedures were performed on Americans in 2002, according to the American Society for Aesthetic Plastic Surgery.The most common procedures were liposuction, breast augmentation, eyelid surgery, nose reshaping, and breast reduction.These figures do not include reconstructive operations."Any television show must be questioned," said Dr. a A. Moynihan, a plastic surgeon who practices in Waterbury and New York City."These patients are shown undergoing several operations and making major changes," she said."Patients should not believe it’s that simple. Most doctors don’t do multiple operations at once" because of the risks posed by prolonged general anesthesia, Moynihan said.Nor do viewers see swollen, painful and bruised patients immediately after surgery."They don’t see long term effects on the psyche, either," Moynihan said."The goal is to improve the way the patient looks, not make them unrecognizable," she said.Seeing an alien beauty in the mirror can lead to serious psychological identity problems, she said.Who is the real you? The new face or the old personality? Is there even a real you anymore?"People should make rational decisions. These shows will make non-candidates feel that plastic surgery is a panacea," Moynihan said.She has an even dimmer view of Nip/Tuck.Actors play sleazy doctors who seduce and abuse patients, breaking almost every medical ethic. Tawdry high jinks are interrupted by gory surgical footage."That trivializes plastic surgery. That’s showmanship rather than educational," she said.Moynihan and other doctors said they’ve seen clinical evidence of the TV shows in their practices."I’ve seen several patients with unrealistic expectations. Several want multiple procedures. I’ve refused some outright," Moynihan said.Dr. Deborah Pan, a plastic and reconstructive surgeon in New Haven, said the shows suggest that all work can be done in one shot, but this is rarely the case."Procedure time is widely variable, depending on the condition of the patient. Most procedures are three to four hours," she said.The most popular aesthetic surgeries are not as simple as they look. The American Society for Aesthetic Plastic Surgery explains:âLiposuction: Small incisions are made near the area to be suctioned. The surgeon then inserts a hollow tube called a cannula, which is connected to a suction pump. Fat is then sucked out. After a few weeks bruises will disappear and the regional should regain normal sensation.âBreast augmentation: Inconspicuous incisions are made and an implant is inserted either underneath the chest wall muscle or directly behind the breast tissue. Most swelling will subside after several weeks and the woman may stop wearing the special support bra.âEyelid surgery: Incisions are made in the upper and lower eyelids. Underlying fat along with excess skin and muscle is removed. âRhinoplasty: Incisions are made inside the nostrils. The surgeon uses a chisel or rasp to remove "bumps." Swelling may be present for months and final results not apparent for a year.âBreast reduction: Incisions are made. Excess tissue, fat and skin are removed. Breasts are reshaped. After a few months breasts settle into a more natural shape.Pan said she turns away 20 to 30 percent of would-be patients because they have unrealistic expectations or the wrong motivation.A prettier nose, flatter abdomen, or smoothly curved buttocks will not save a terminal marriage. Women who augment their breasts may receive more male attention, but pick-up lines and leering are not apt to cure loneliness.Vanity is not restricted to women. Men cling to similar fantasies of becoming successful by looking younger.What’s the right motivation?People who seek to modify their aging appearance to match how youthful they feel are usually on the right track, Pan said.Pan said people interested in plastic surgery should consult physicians who are board certified. Doctors can call themselves "aesthetic surgeons" without having any additional training, she said.Simone, of Manhattan, said fascination with plastic surgery and the two television shows tap into a maelstrom of cultural and social issues surrounding personal appearance."It’s wonderful going though life being good-looking, with beautiful breasts and an attractive figure. People are obese and they have skin problems. They don’t necessarily have to stay that way. It makes more business for plastic surgery," he said.Physically beautiful people are perceived as being more intelligent and competent, Simone said."If something is correctable and safe, there’s no reason not to do it. If someone sees one of these programs, sees there is a potential for improvement, educates herself, if they make a well-informed decision, it will work for them," Simone said."Aesthetic surgery is not the most important thing in life. Where does it fall? In people who have the means then it has relative importance."We’re in a quick-fix society," Simone said.