Introduction
Despite the wealth of resources at our disposal there still remains a great deal of confusion about cosmetic and plastic surgeries, with some of the most common misconceptions deriving from pop culture.
As a society, we’re inundated with photos on Instagram and other social media platforms depicting celebrities who have undergone multiple surgeries. The TV series I Want a Famous Face, for example, portrays plastic surgery as a way for people to resemble high-profile celebrities, such as Jennifer Lopez or Brad Pitt. But at its core, such operations aren’t about transforming yourself into someone else, but rather looking and feeling your best, and there’s no shame in that. The constant myths and rumors surrounding the specialty can give it a bad rap.
“The most common misconception is the generalized idea of what plastic and cosmetic surgery entails,” said Dr. Anthony Buglino, plastic and cosmetic surgeon and owner of Buglino Plastic & Reconstructive Surgery. “A lot of it is what the population sees on TV, where it’s mostly about filler and botox. The shows don’t tap into all of the life-changing procedures we perform, the reconstructive aspect as well.”
The American Society of Plastic Surgeons (ASPS) reported that in 2018 alone Americans underwent a total of 17.7 million cosmetic and 5.8 million reconstructive procedures. The top five cosmetic surgical procedures were breast augmentation, liposuction, rhinoplasty, blepharoplasty, and tummy tuck, while the top five minimally-invasive cosmetic procedures were Botulinum Toxin Type A, soft tissue fillers, chemical peels, laser hair removal, and microdermabrasion. The most performed reconstructive procedures included tumor removal, laceration repair, maxillofacial surgery, scar revision, and breast reconstruction.
With so many Americans considering undergoing procedures, and potentially being influenced by what they see on social media, television, and in magazines, it’s important that they diligently gather information from reputable sources.
Let’s start with the field itself. Many assume cosmetic and plastic surgery are one in the same. However, the two have distinct differences. Cosmetic surgery is performed to enhance appearances through surgical and medical techniques, while plastic surgery (aesthetic and reconstructive) treats the body affected aesthetically or functionally by infection, tumors, disease, congenital defects, developmental abnormalities, or trauma.
We put this resource together in hopes of debunking common plastic and cosmetic surgery myths:
CHAPTER 1
Anesthesia
When thinking about how plastic and cosmetic procedures are performed, you may imagine they’re all completed under general anesthesia. But, this isn’t always the case. Sometimes sedation, or even local anesthesia, is used.
General anesthesia, a combination of intravenous (IV) drugs and inhaled gases designed to put patients in a sleep-like state, is often used during lengthy procedures which have the potential to result in significant blood loss, expose the patient to a cold environment, or affect his/her breathing. Tummy tucks and body lifts require this form of anesthesia, which may result in side effects such as grogginess, confusion, nausea, dry mouth, sore throat, muscle aches, and more.
Many procedures, including implant removals and lower eyelid surgery, can be completed while a patient is under sedation (also known as twilight). There are multiple levels that can be administered through IV: minimal, moderate, and deep. When the patient wakes up from this form of pain relief, he/she may experience symptoms including drowsiness, sluggishness, slow reflexes, and headaches.
Local anesthesia is numbing medication administered in the form of an injection or topical solution, and is generally combined with a sedative pill during procedures such as liposuction. This type of pain reliever has fewer side effects than either general anesthesia or sedation, namely headaches, dizziness, and twitching muscles.
CHAPTER 2
Body Contouring
The term “body contouring” encompasses liposuction, abdominoplasty (tummy tuck), brachioplasty (arm lift), buttock lift, body lift, inner thigh lift, panniculectomy, skin contouring, as well as breast lifts, augmentations, and reductions.
“Body contouring is a general category, and is anything that’s going to be changing the body’s shape,” said Dr. Buglino. “It could be cutting, sewing, and removing fat to improve upon natural peaks and valleys in the body.”
Popular body contouring myths include:
- Liposuction and skin contouring are the same.
Liposuction suctions fat from various areas of the body, while skin contouring is the removal of excess skin.
- Body contouring gets rid of cellulite.
Body contouring can’t get rid of cellulite, but there are other options. Patients can undergo minimally invasive procedures such as Cellfina or Sculptra injections. Results can last up to greater than two years.
- You can’t get pregnant after a tummy tuck.
You can get pregnant after a tummy tuck. However, it’s recommended that people interested in such a procedure delay doing so until after your final pregnancy.
- The optimal time for a tummy tuck is in conjunction with a c-section.
To see the best possible results, new mothers should wait at least six months after a c-section to have a tummy tuck for appropriate skin and muscle retraction.
- A Brazilian butt lift is a single procedure that enlarges the buttocks.
A butt lift consists of two procedures: liposuction to remove fat from areas with excess and a transfer to the buttock to increase volume and enhance shape.
Perhaps the most common misconception is perceiving body contouring as a means of losing weight, and for a variety of reasons the procedures should never be misunderstood as such. Each person contains a fixed number of fat cells, which either increase or decrease in size as you gain or lose weight. Body contouring surgeries are designed to remove or destroy these cells, giving the body a thinner appearance. Although the lost cells cannot regenerate, those remaining retain the ability to expand or contract. So, in reality, you’ve lost fat cells, not weight.
Dr. Buglino is a proponent of the “whole-person” approach to treatment and care, which informs his practice of discussing alterations to nutrition and lifestyle prior to performing any procedures, in order to ensure the best outcome for patients.
“You’re never going to have a great result if you don’t continue to maintain what you’re putting in your body,” said Dr. Buglino. “If some patients need to lose a little weight, and I think if I aggressively remove fat quickly they’re going to have skin laxity, I’ll tell them it’ll work best if they lose the weight first.”
CHAPTER 3
Breast Surgery
A form of body contouring, breast surgeries—including augmentations, implant removals, lifts, and reductions in both men and women—made up more than 500,000 of the 1.8 million total cosmetic surgical procedures performed in 2018.
Many believe augmentations and lifts are one and the same. The truth is the two serve vastly different purposes. While the goal of augmentations is to increase breast size, lifts are primarily designed to fix droopiness. Anyone interested in a procedure needs to figure out which one to have or whether you should consider both. Dr. Buglino explains that this decision comes down to fine measurements and a skin quality assessment during a consultation.
“The degree of ptosis of a breast needs to be assessed,” he said. “Depending on how much ptosis or skin sagging your breast has, augmentation alone may be sufficient or one may require excess skin removal and tightening as well.”
Augmentation is used if you want more volume/upper pole fullness, and a lift is performed if you want to improve the “perkiness” shape and contour of the breast.
“You can not compensate for upper pole fullness with a lift—you need an implant,” he added. “I made my own protocol for that. If the nipple needs to be raised more than five centimeters, it needs to be done in two stages. If it’s less than that, you could do a combination (augmentation/mastopexy) in one stage.”
While breast implants don’t increase a patient’s risk of being diagnosed with breast cancer, in 2019, the Food and Drug Administration (FDA) identified a possible association between textured breast implants and the development of anaplastic large cell lymphoma (ALCL). In response, the FDA recalled multiple textured breast implant styles and tissue expanders to protect patients. If you have one of the recalled implants, you may want to have it replaced.
But if you don’t have one, despite popular belief, you most likely won’t need to have it replaced after 10 years. The ASPS explains there is no expiration date on an implant. They should only be replaced if they rupture or deflate, a patient develops a capsule contracture, or he or she is dissatisfied with the original results.
And for women who have breast surgery, breastfeeding is an option after receiving implants or a reduction. An implant is placed between the chest wall and breast, so it doesn’t interfere with ducts or mammary glands. This means women who have implants can still continue to produce milk. During a reduction, enough breast tissue is generally left to allow breastfeeding as well.
CHAPTER 4
Facial Surgery
Facial surgery, similar to body contouring, is a term encompassing a wide variety of procedures from facelifts and eyelid surgery to rhinoplasty and chin implants. With the many types of surgeries come many tall tales and rumors.
Although facelifts are known to restore a youthful appearance, there’s still an outdated notion that these procedures are simply for older generations, which is far from the truth. More men and women are starting to address their sagging skin and wrinkles at a younger age. The ASPS reports more than 39,000 people between the ages of 40 and 54 underwent facelifts, in addition to roughly 80,000 ages 55 and older in 2018.
While some regard Botox and other injectable treatments as alternatives to facelift, these methods won’t provide the same results. Facelifts typically last longer than Botox, which generally requires a refresh after a period of about three months. Botox is also unable to provide as drastic of a change as a facelift.
Many also assume eye lifts include, or are interchangeable with, brow lifts, but the two procedures tackle very separate issues. An eye lift is designed to repair upper eyelid drooping and under-eye bags and wrinkles, while a brow lift works to improve the appearance of the forehead, brow, and portions of the upper eyelid.
Similar to how thin brows were once all the rage, nose jobs have evolved through the years. Previously, the primary motivation for rhinoplasty was in pursuit of the “perfect,” yet seemingly elusive, bumpless nose. But, in 2018, Allure and other beauty sites reported plastic surgeons had seen a rise in patients looking for a unique nose, rather than perfection.
CHAPTER 5
Non-Surgical
Non-surgical plastic and cosmetic procedures, with headlines debating whether or not Hollywood stars have received Botox or fillers, may be the one area most beset by rumor and debunked claims. Even celebrities themselves buy into Botox clichés. Olivia Wilde, for instance, told Allure, “Botox makes everyone look like a wax candle”—which, of course, is not true.
“Botox is for preventing wrinkles while maintaining movement in the face,” said Buglino. “But not sharp movements that will create wrinkles.”
Similar to Botox, it’s widely speculated that dermal fillers don’t look natural—but it all depends how they’re administered and the particular look you’re going for. Dermal fillers are not immune to misconceptions pervasive in this industry. One of the most common: All fillers can be used on any area of the face. It’s important to note that only a select list of these injectables are approved by the FDA, and those fillers have specific indications for injection areas.
A third form of injection, platelet-rich plasma (PRP), is widely associated with the so-called “vampire facial” Kim Kardashian had a few years ago, during which she received microdermabrasion followed by a PRP mask. But PRP treatments have since been used for so much more including facelifts and hair regrowth.
“There are a lot of people who are just scared of hair transplants—just the sound of it, they think of plugs,” said Dr. Buglino. “They’d rather regenerate their own hair. PRP is something you can harvest from your own body. PRP has been shown to increase growth, thickness and integrity of hair.”
While these non-surgical procedures are often believed to be painful due to the use of needles, this is seldom the case. The needles are typically quite small, making each injection feel like a simple pin prick. Additionally, when receiving microneedling treatments, doctors use a topical anesthetic to reduce pain.
CHAPTER 6
Skincare
Skincare has become a booming industry, with sales of products growing 13 percent in 2018, compared to makeup sales, which merely increased by 1 percent. There’s no single answer to why the obsession with skincare is on the rise just yet, but whatever the reason, skincare treatments and regimens make our faces clearer and give us that dewy glow.
There are thousands of treatments and products on the market, so it’s important to understand the truth about some of the most popular treatments.
According to Yelp15, which highlighted the review site’s trend research over its 15 years in existence, hydrafacials have seen a precipitous rise in Yelp mentions and popularity since 2004. This spa service incorporates a non-painful suction device, designed to eliminate impurities prior to infusing a serum into the skin. Hydrafacials are often used to even skin tone, unclog pores, kill acne bacteria, and improve hydration.
Used to treat wrinkles, skin discoloration, and scars, a chemical peel removes layers of skin and skin cells to unveil a fresh, new layer. After either a light, medium or deep treatment, your skin may peel anywhere from three to 10 days.
For those looking to address sun spots, rosacea, and age spots, an Intense Pulsed Light (IPL) treatment may be a viable solution. If you’re looking to take it a step further and target acne scars, stretch marks, wrinkles, and hyperpigmentation, laser treatments could potentially be the way to go.
On top of visiting a medispa every so often, it’s crucial to apply a multi-approach skincare regimen each day and night, though it’s not necessary to use 20 different products and 12-step routines, as many brands would have you believe. The four basic steps are:
- Cleanse: Use a cleanser daily and an exfoliator once or twice a week.
- Treat: Try different serums to address various concerns, or use an acne relief cream.
- Moisturize: Because skin loses its ability to retain moisture, creams, lotions, and balms should be applied year-round.
- Protect: No matter the weather, a sunscreen with an SPF of at least 30 should be used daily.
CHAPTER 7
Corrective & Reconstructive
Plastic and cosmetic surgery isn’t done solely for the purposes of adapting appearances—in many ways, it’s about changing someone’s outlook on life. While altering aesthetics may make some people feel good, other procedures have the potential to completely change a patient’s well-being and lifestyle.
For instance, plastic surgeons are able to reconstruct breasts for women who have gone through mastectomies. According to the Mayo Clinic, a nonprofit academic medical center, breast reconstruction can both improve self-esteem and body image, and partially erase the physical reminders of breast cancer. Although this surgery, which usually involves adding tissue expanders and implants, won’t make breasts appear exactly as they did before, the procedure can provide a similar breast contour, improved symmetry, and help you avoid the need for a foam or prosthetic inside your bra.
Along these lines, “body contouring after a massive weight loss completely changes patients’ lifestyles,” said Dr. Buglino. “We consider a massive weight loss 100 pounds or more, and they tend to be left with residual skin laxity of the arms, abdomen, and thighs—extra skin they just can’t function well with. So body contouring gets them back and mobilizing. It’s a new way of life after weight loss.”
The “Body Contouring Following Massive Weight Loss” study concluded that full emotional rehabilitation for patients who have experienced extreme weight loss comes after removing the excess skin and tissue. Once the surgery is performed, they’re able to see the results of their hard work. Another study found that abdominal contouring surgery can improve function after weight loss as well.
With the fictional tales told on television, social media, in magazines, and sometimes by friends, it’s best to conduct independent research or consult a physician if you’re interested in a procedure. Plastic and cosmetic surgery are about making people feel more confident and live better lives—don’t let common misconceptions inform your decisions.
