DrG's Medisense Feature Article

Promise of Youth: Cosmetic Procedures
by Ann Gerhardt, MD
September 2015
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If you can’t be young, why not look young? As the women who have undergone multiple surgeries prove, there’s no end to the ways plastic surgeons can modify the visible evidence of aging. One woman has had 37 surgeries, resulting in size QQQ breasts and puffed out lips that look like the wax-candy lips of yesteryear.

Cosmetic procedures encompass a range of options – liposuction, collagen injections, derm-abrasion, permanent make-up, collagen or Botox injections, hair transplants and various “plasty” surgeries. Any procedure whose name ends in ‘plasty’ involves corrective surgery. A rhinoplasty is a nose job. Blepharoplasty is an eyelid lift. A face lift is a rhytidoplasty. Lipoplasty, or liposuction, pulls fat out from under the skin. Some, like breast reconstruction after mastectomy, skin grafting after burns and blepharoplasty for people whose eyelids have slumped so far they impair vision might be considered medically necessary. Most others, of which a comprehensive list is available on the American Society of Plastic Surgeons’ website, are cosmetic.

Plastic surgery and other cosmetic procedures may stretch wrinkles, carve away loose skin folds and suck out fat, but they don’t make the face, butt, chest or body any younger. They certainly don’t slow your internal organs’ aging, unless the calm achieved by a youthful look leads to less stress.

Many people accept that these procedures don’t regenerate youth, but, in an effort to look young. they turn a blind eye to their potential danger. No matter how innocuous cosmetic procedures may seem, they carry risk. After all, someone is invading the body with a scalpel, needle or chemical. Complications range from wound infection, poor healing and red, bumpy scars to life-threatening events like heart attack, abnormal cardiac rhythms, stroke, paralysis, nerve or brain damage, blood clots, airway obstruction, and death. Liposuction deaths occur when bleeding can’t be stopped or when bits of fat break off and clog an artery to the brain or lung.

Even something as simple as a collagen injection can have adverse consequences. Collagen and other ‘fillers’ are used to puff out lips, cheeks and other wrinkled areas. A recent report describes skin damage, blindness or stroke resulting from the filler inadvertently entering the area’s blood vessels. As the filler clogs the vessel, tissue dies as a result of its blood supply being blocked.

The plastic surgery board says that board-certified plastic surgeons have good track records and put the death rate at 1 in 57,000. They include all types of cosmetic procedures, including low risk fillers and permanent make-up. Mortality from surgical procedures depends on the type of procedure and surgeon’s skill, in one report 1 in 2340 patients. Liposuction may seem innocuous, but carries a significant risk of death, at 1 in 5000 and generates many more non-fatal complications. (References below).

That may not sound too bad until it is you. Did the 38-year-old former Miss Argentina who died from a blood clot to her lung after cosmetic surgery on her buttocks really think that a perky butt was worth death? Did the plastic surgeon warn his wife that she could die prior to her bleeding to death as he performed liposuction? The mortality rate may be low but is higher than that caused by a saggy butt or droopy cheeks.

There’s also the problem of the implant never aging. The adjacent skin sags around the forever-firm implant. I had a patient whose breast implants ended up like balls in socks as they weighted down her aging chest skin. It’s really nothing that repeated plastic surgery couldn’t fix… until it happens again.

In some people facelifts actually increase the rate of subsequent skin sagging. Detaching skin from its underlying tissue eliminates natural anti-aging mechanisms, including muscles under the skin which help to hold it in place and blood vessels which deliver blood to keep it healthy. Also, the stretched skin is thinner, without the underlying fat layer typical of young skin. People who lose a lot of weight often notice new wrinkles that weren’t part of their fat face. Plastic surgery may look good initially, but after the surgery-induced swelling abates, sagging can occur faster than ever.

Susan Sarandon, who has foregone plastic surgery and looks beautiful at age 68 has said, “There’s the inevitability of the deterioration of the physical that forces you to think, really, what is beauty and what survives… It’s a losing battle if you’re trying to still look 22. You’re going to be disappointed.”

And, I would add, probably look silly trying. Plastic surgery might make you look younger, or it may just make you looked stretched and really weird. I’ve often thought that old people with perfect, plastic faces and vein-popping decrepit hands look like a product manufactured with mismatched parts.

Even a beautiful outcome, though, doesn’t make your aching joints, clogged-artery heart or “why-did-I-come-into-this-room” brain any younger. A man dead at age 50 of a heart attack may look young with his hair transplants and liposuction, but he’s still dead.

So why try? If it makes you feel better, and doesn’t kill you, at least you are supporting the economy. However, if you don’t buy the magic creams, plastic surgery, spa makeover, appearance thing, the money you save could be used for an invigorating pole dance class or trek through the Alps.

A few references:
Grazer FM, de Jong RH. Fatal outcomes from liposuction: census survey of cosmetic surgeons. Plastic Reconstr Surg 2000;105:436-46. (Liposuction mortality)

Levine SM, Wilson SC, et al. Plastic surgery mortality: An 11-year, sincle-institution experience. Ann Plastic Surg 2015; not yet in print. (Total mortality)

Cardenas-Camarena L, et al. Deaths caused by gluteal lipoinjection: What are we doing wrong? Plastic Reconstr Surg 2015;136:58-66

Saad AN, et al. Risk of adverse outcomes when plastic surgery procedures are combined. Plastic Reconstr Surg 2014;134:1415-22. (Venous clogging).

Wang HD et al. Fat embolism syndromes following liposuction. Aesthetic Plastic Surg 2008;32:731-6