Dear Editor:

I read Robert Johnson’s article “A Nip and a Tuck” about cosmetic surgery for the 65-plus crowd that appeared in the October 31, 2011 WSJ.  The article only mentions a single specialty that offers cosmetic surgery: general plastic surgeons certified by the American Board of Plastic Surgery.  Either general plastic surgeons are very good at public relations (they are), or the author was unmotivated to provide readers with a balanced perspective.  General plastic surgeons are not the only board certified surgeons who offer safe, high quality cosmetic surgery.

For years general plastic surgeons failed to train their residents for cosmetic surgery. General plastic surgery residency instead focused on broad training in reconstructive general plastic surgery.  Despite claims to the contrary, treating a burn is not the same as performing liposuction, a facelift, or an eyelid surgery.  This lack of leadership has resulted in a less than ideal standard of care for these elective cosmetic surgeries.

Over the past 40 years, otolaryngologists, ophthalmologists and dermatologists have built excellent fellowship training programs in facial plastic surgery, oculofacial plastic surgery, and dermatologic surgery that provide in-depth training in cosmetic surgery to allow these surgeons to offer cosmetic surgery to the American public that is arguably safer and of better quality than that offered by general plastic surgeons.   The American Board of Cosmetic Surgery, a non-ACGME board, accredits high quality cosmetic surgery fellowships that are open to a number of surgical specialties including general surgeons, gynecologists, oral maxillofacial surgeons, as well as general plastic surgeons. These highly trained specialists provide a quality alternative to board certified general plastic surgeons who lack formal training in cosmetic surgery.  It is now well accepted that fellowship trained dermatologists practicing liposuction are much less likely to be sued for liposuction malpractice than general plastic surgeons to cite just one example.

It is not controversial to state that general plastic surgery residencies do not provide adequate training in cosmetic surgery.   Fortunately the field of general plastic surgery has recognized this and now offers a growing number of fellowships in aesthetic surgery for board eligible general plastic surgeons.  However, compared to fellowship trained specialists in facial plastic surgery, oculoplastic surgery, dermatologic surgery, and cosmetic surgery; general plastic surgeons still have a ways to go before the public trust in this specialty is truly deserved. Unfortunately readers of Mr. Johnson’s article were left unenlightened about these issues.

Sincerely,

Kenneth D. Steinsapir, M.D., Los Angeles, Ca.

Associate Clinical Professor

Division of Orbital and Ophthalmic Plastic Surgery

Jules Stein Eye Institute

David Geffen School of Medicine at UCLA

Many people travel from across the United States as well as internationally to have surgery with Dr. Steinsapir.  He is world-renowned for his leadership in facial cosmetic surgery.  If you are considering traveling to have reconstructive surgery or other cosmetic treatment with Dr. Steinsapir, here are some important considerations that will help you have the best experience possible.

Consult First

Many people who travel for cosmetic treatment feel they should be able to have surgery at the time of their initial consultation.  They want to take care of everything in just one trip, so they may fly or make a long drive to Los Angeles, have their consultation, and have surgery all during the same trip.  This idea may seem appealing because you only have to book a flight and pack your suitcase once, and you may even save a little money—but please reconsider this approach.  Dr. Steinsapir doesn’t believe in performing an initial consultation and surgery at the same time.  Even if you save a few dollars in airfare, in the end this amounts to hasty and high-pressure decisions.  Your choice to move forward in having surgery with the right doctor is important, and it’s not a good idea to cut corners here.

Reconstructive surgery should be something you and your surgeon approach calmly, thoughtfully, and with confidence.  Instead of too much pressure, Dr. Steinsapir strongly advises and encourages you to take the time to make sure you have found the right doctor and right treatment approach.  He wants you to have time to think about the options and be completely comfortable with the proposed surgical plan.

Take Time to Reflect

Consulting now and having surgery later is a sound approach for anyone seeking the right cosmetic treatment with any doctor.  Although admittedly not convenient, slowing down, thinking about your choices and being fully comfortable ensures that you can make a fully informed choice without the pressure of time.  When you consult with Dr. Steinsapir, he won’t pressure you into committing to surgery.  It is better for everyone if you have the opportunity to meet with the surgeon, then have time to think about the issues discussed well before undergoing reconstructive surgery.

Make Thoughtful Decisions

Even if you’re traveling from very far, Dr. Steinsapir will not perform surgery at the time of your initial consultation.  The best surgery is always performed with the utmost of care, consideration, research, and planning.  You should go into surgery comfortable and confident that you have made the right decision.

About Dr. Steinsapir

Dr. Steinsapir is on active staff at the UCLA Hospital and Medical Center at the David Geffen School of Medicine as an associate clinical professor of Ophthalmology in the Division of Orbital and Ophthalmic Plastic Surgery. UCLA is consistently rated the best hospital in the West and ranked third among all medical centers in the United States. Many surgeries are performed on an outpatient basis at the Surgery Center at the UCLA Medical Center. Larger procedures may also be performed on an inpatient basis at the Jules Stein Eye Institute. Dr. Steinsapir addresses a broad array of oculofacial reconstructive concerns.  Contact us today to schedule a consultation, followed by a brief consideration of the more common reconstructive issues that bring people to see Dr. Steinsapir.

Consider the impact of surgery

While television programs are full of stories about how plastic surgery transformed the lives of the patients, these grand results are much less common than the TV might lead you to believe. An improved upper eyelid won’t suddenly transform your life by helping you to get a better job, end conflict with your spouse, or make you an instant celebrity.  A realistic goal is that you will be pleased with the improvement and happy that you had surgery.  However, it is unrealistic to expect the surgery will help you land that promotion and help you pay off the cost of surgery. Don’t opt for surgery if it is a choice between basic necessities and having surgery.  Paying rent and health insurance is more important than elective cosmetic surgery.  These are personal choices, but cosmetic surgery is a luxury and not a necessity.  Make sure you aren’t over committing yourself financially in deciding to have surgery.

Consider your motivations

Before deciding to undergo cosmetic surgery, ask yourself “why.”  The first step to understanding if you are ready for surgery is to understand your motivations.  Do you want surgery to please yourself, or to please someone else?  There is no right answer, but if you want surgery to please someone else, ask yourself if the surgical outcomes are something you also want.  Do you find yourself preoccupied with thoughts of a particular surgery?  Do you avoid social situations because you are concerned that people are staring or whispering about you?  Do you spend hours every day repeatedly thinking about an issue that your friends have trouble seeing?  These may be signs of a condition called body dysmorphic disorder.  Body dysmorphic disorder is an obsessive thought pattern characterized by focusing on a slight or nonexistant flaw. Unfortunately, it is difficult to fix subtle or nonexistent issues surgically.  Occasionally this leads to a flat out misunderstanding between surgeon and patient, and even more trouble after surgery.  Dr. Steinsapir find that it is best to air these issues openly and if necessary involve a psychotherapist to help the individual better understand their motivation to have surgery.

Consider your support system

One last series of questions you should ask yourself is about support from family and friends.  Are others around you supportive of you having cosmetic surgery?  Keep in mind that a negative environment can be harmful to your healing process following surgery.  It is so important to make sure those you love are supportive of your decision before you undergo cosmetic surgery.  Don’t try to hide the fact that you are undergoing cosmetic surgery; be open about your plans and find support from those around you.

About Dr. Steinsapir

Dr. Steinsapir is a board certified ophthalmologist and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology.  Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA.  Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert provider of cosmetic surgery.

Reality vs. Reality Television

When it comes to cosmetic surgery reality shows, the term “reality” becomes a very loose term.  These programs have ridden (some would say helped to stimulate) the wave of interest in cosmetic surgery, yet they provide only a very distorted view of the practice of cosmetic surgery. The consultation becomes a sound bite and in the process minimizes the risks and appropriate concerns that must be addressed.  So many procedures are performed on some of these shows at one time that the surgery becomes unnecessarily life threatening.  No one should be placed in a position of choosing between their beauty and their health.  Of course there are risks with any surgery and anesthesia.  However, these risks can be managed and reduced by using the most appropriate anesthesia, operating in the proper setting, and limiting the amount of surgery performed at a given time.

Choosing the right doctor

By playing on your desire for a “quick fix,” advertisers are reinforcing the misconception that cosmetic surgery is just another quick trip to the doctor’s office; like receiving a flu shot.  But just as a flu shot comes with risks, so too does cosmetic surgery.  Although there are risks with any surgeon and procedure, an expert surgeon will guide you through these risks helping you to make an informed decision.  Offices that gloss over these concerns are trying to take advantage of your lack of expert knowledge.  It is the job of the surgeon and their staff to educate you and help you make the right decision, not hustle you into having surgery.  At the end of the day it is essential that you trust your doctor.  It goes without saying that your doctor should make sense, listen to you, and treat you with respect and dignity.  The office staff should also listen to your concerns and treat you with respect. Don’t be intimidated by the doctor’s reputation.  That reputation is meaningless if the doctor doesn’t treat you like a human being.  Before and after pictures are also extremely important. This is generally a doctor’s best work. If you don’t like what you are seeing, it is a mistake to think your results with that particular doctor will be better than what you are being shown.

Consultation is key

Whether you decide to seek help from a clinic advertised on TV, or to take the recommendations of a friend or family member, it’s important to first attend a consultation with your chosen physician.  That consultation should also include meaningful time with the surgeon who will be doing your surgery.  If the surgeon is not detailed during your consultation, is it reasonable to assume they will be detailed in performing your surgery?  To get the most from a consultation, do your homework. Have a good idea of what you are trying to accomplish. Be open to an approach that is different from what you thought you needed.  Choose your surgeon based on his or her expertise, not based on media hype or discounts.  If you don’t like what you are being told, don’t try to convince the surgeon to do something they have just advised you to avoid.  Instead, consider seeking a second opinion to ensure your surgeon is giving you the options that he or she is most comfortable with and the safest possible plan-of-action.  The good news is that in most cities, there are lots of options for cosmetic surgery care. No one person has all the answers.  If all the other doctors you have seen recommend against a particular course, think long and hard about allowing that surgeon to perform your surgery.

About Dr. Steinsapir

Dr. Steinsapir is a board certified ophthalmologist and fellowship trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology.  Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA.  Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert provider of BOTOX, DYSPORT, Restylane and Perlane, and advanced eyelid and facial surgery, which can be a vital part of your evidence-based treatment plan.

Midrodroplet BOTOX process

The Microdroplet BOTOX process controls the depth and distribution of the BOTOX to maximize a natural lift of the eyebrows while preserving natural forehead movement.  This method differs from the way BOTOX is traditionally injected because it prevents unwanted eyebrow pinch and allows you to continue to move your eyebrows naturally.  Microdroplet BOTOX lifts the brow, opening up the eyes to give you a more youthful appearance, but without causing the traditional forehead freeze.

About Dr. Steinsapir

Dr. Steinsapir trained alongside the inventor of BOTOX and has performed thousands of BOTOX treatments in Los Angeles since 1988 and recently patented his Microdroplet BOTOX technique. He is a board certified eye surgeon and fellowship trained in oculoplastic surgery and cosmetic surgery in Southern California where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert provider of BOTOX.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success.  Only you and your treating physician or surgeon can determine if a treatment is right for you.

Private surgery centers

Accredited surgery centers run by your surgeon’s office are generally safe, but Dr. Steinsapir believes there is inherent security offered by major medical centers that is difficult to duplicate in small surgery centers.  Dr. Steinsapir notes that, while it is certainly more profitable and convenient for a surgeon to run his or her own surgery center, patient safety is a central focus of major medical centers, and therefore they are often a safer option for the patient. One of the great advantages of a major medical center is increased peer scrutiny and clinical resources.  There are simply more people looking over the surgeon’s shoulder.  At a private operating room, there is a single anesthesiologist and perhaps two nurses, or a nurse and a nurse anesthetist working with your surgeon.  There is a very low incidence of issues in operating rooms, however, if an issue does arise, the available staff members and attending physicians are limited.  Who is around to assist your surgeon and their anesthesiologist?

UCLA Surgery Center

The UCLA Surgery Center is not only staffed with numerous anesthesiologists, nurse anesthetists, respiratory therapists, and critical care nurses, but all staff members are up-to-date on the latest techniques.  The anesthesiologists are not community-based.  UCLA Surgery Center anesthesiologists are also academic faculty members actively involved in the latest developments in anesthesia as well as teachers of the next generation of anesthesiologists; they know their business.  The surgery center is on the campus of the Ronald Reagan Medical Center with all the resources that modern medicine has to offer.  You might inquire if your surgeon’s office-based operating room has a plan should something go wrong, but at UCLA you know you are in good hands.

Cost benefits of UCLA Surgery Center

Your surgeon’s private surgery center offers a convenience if your surgeon is local, but UCLA Surgery Center offers remarkably competitive facility and anesthesiology fees.  In many cases, the rates are lower than those of many private surgery centers (in some cases, much lower).  It is comforting to know that the safety of the UCLA Medical Center is within financial reach for your cosmetic surgery.

About Dr. Steinsapir

Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology.  Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA.  Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success.  Only you and your treating physician or surgeon can determine if a treatment is right for you.

Asian eyelid surgery before and after

What exactly is an anchor blepharoplasty?

An anchor blepharoplasty is an important part of any comprehensive blepharoplasty. This part of your surgery specifically addresses loose skin and drooping eyelashes on the upper eyelid platform. Excess, wrinkled, or loose skin here can give you a tired appearance associated with eyelid ptosis, or sagging eyelids. The anchor blepharoplasty for Asian eyelids restores your
alert, youthful appearance by correcting the tension in the upper eyelid skin and positioning your eyelashes to a more optimal position.

How should my oculoplastic surgeon address my Asian anchor blepharoplasty?

As with any Asian eyelid surgery, when your cosmetic surgeon develops your treatment plan, he or she should customize it to your unique features and understand that the goal is never to “westernize” the eye, but instead to optimize your natural eyelid features to bring out a look that fits you as perfectly as possible. The best blepharoplasty for you will be one that enhances
your individual aesthetic.

Asian eye surgery is a specialized cosmetic surgery that calls for an eye plastic surgeon who has helped many people achieve great Asian eye surgery results by understanding that treatment needs vary on an individual basis. Choose a doctor who has much experience in helping others achieve natural-looking Asian eyelid surgery outcomes.

A Specialized and Technical Skill

While ideally anchor blepharoplasty is a part of every blepharoplasty, unspecialized or less skilled surgeons may not be comfortable offering this important aspect of treatment.  That’s because anchor blepharoplasty is a very technical skill that requires great precision and specialized expertise. Without great experience, education, and an artistic skill, your cosmetic doctor may have difficulty performing an anchor blepharoplasty as part of your upper blepharoplasty; unfortunately, in these cases you find yourself disappointed after you heal and wish your eyes appeared more alert. The proper tension achieved through an expert anchor blepharoplasty is what you need to improve lash ptosis, skin laxity on the eyelid platform and
related problems.

Choosing the Right Surgeon

When you are seeking the best eye plastic surgeon for you, consider who has a reputation of excellence in issues most important to your treatment, like the best Asian eyelid surgery, superior ethics and care, a grounded education and experience base, and a proven ability to achieve natural and balanced results. Make a list of what you seek in a fellowship trained surgeon recognized by the American Society for Ophthalmic Plastic and Reconstructive Surgery and do not settle for any less than the best for your unique situation.

We hope that during your search you will consider how a no-risk consultation with Dr. Steinsapir can give you insight and confidence in your treatment options. Dr. Steinsapir practices minimally invasive facial cosmetic solutions in Los Angeles, with a specialty in Asian eyelid surgery. As a top eye plastic surgeon and leader in this field, Dr. Steinsapir has published many articles and is renowned for his forward-thinking, science-based solutions that result in a natural look and fast healing time. Contact us today to learn more about how Dr. Steinsapir can help you achieve the facial balance you’ve been wanting.

It’s appealing to believe that we can resolve all of our concerns through exercise, and while research shows that exercise does benefit our health in many ways, it also shows that further medical treatment is required for many conditions.  Just as someone with presbyopia cannot exercise to regain the ability to focus for reading vision, it’s not likely that you’ll be able to reverse the effects of age, time, gravity, and stress by wiggling your face or by having electrical currents stimulate your facial muscle to contract.

There are many types of facial cosmetic surgery and other treatment that can help you obtain the result you need if your doctor determines that you are a suitable candidate.  These range from minimally invasive treatments with little-to-no downtime like BOTOX and undereye Restylane to surgeries like the facelift and plastic eyelid surgery including eyelid reconstruction, which give dramatic yet natural results to individuals with far-reaching concerns.  While it is impossible to know which treatment, if any, is most suitable for you before a private consultation with the best facial cosmetic surgeon for you, you can be confident that there are a wide range of treatments that an expert can custom-tailor to meet your needs.

As a specialist in facial cosmetic treatments, Dr. Steinsapir has treated many individuals who first explored a variety of “natural solutions” for their aesthetic facial concerns.  Frustrated when they saw no results, they eventually consulted with Dr. Steinsapir and opted for proven treatment methods that provide dramatic yet natural results.  This human tendency to pursue unproven treatments is not a fault; it is normal to want to independently resolve a problem using the least invasive and most economical method possible.

Dr. Steinsapir is focused on your personal goals and comfort level.  Dr. Steinsapir always asks you questions about your specific goals, individual situation, and preferences so that he can plan a solution that is aligned what you want, so you can feel comfortable knowing that you are ultimately in control of your treatment plan.  Dr. Steinsapir very much believes in using the least invasive method for accomplishing a particular goal; for example, he does not recommend a forehead lift when a BOTOX treatment for wrinkles will will meet your goals – and he is a leader in his field of minimally invasive solutions.

If you are seeking a proven treatment with an experienced facial plastic surgeon with extensive training in oculofacial plastic surgery, we invite you to a personal consultation with Dr. Steinsapir today.  Dr. Steinsapir is honest, friendly, and can talk to you about customized treatments that give you the results you seek by addressing your specific needs and unique facial features.  Please call us today to schedule a time when you can speak with Dr. Steinsapir.

About Dr. Steinsapir

Dr. Steinsapir is a board certified cosmetic surgeon and oculoplastic surgeon in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology.  Dr. Steinsapir has a private practice and also serves patients at UCLA, where he is an assistant
clinical professor. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert provider of facial cosmetic surgery and eyelid reconstruction, which can be a vital part of your evidence-based treatment plan.

FLESH WOUNDS

According to the American Society of Plastic Surgeons (ASPS), over 12 million cosmetic procedures were performed in the United States last year. This represents an increase of 40% over the number of procedures done in 2000, despite the economic recession. One of the reasons why cosmetic surgery has become so popular is in part because it provides an accessible if not always affordable mean to reinvent one’s self. To use the term coined by author Virginia Blum (Flesh Wounds: The Culture of Cosmetic Surgery), we are all “surgical”-potential consumers of cosmetic surgery. Blum suggests that all features become categorized into those that need and don’t need surgical work.

One important fact to note from the ASPS statistics is that 91% of the total cosmetic surgeries in 2008 were performed on women. It is interesting to know that there exists a reverse gender imbalance in the world of cosmetic surgery, where men make up for 91% of the cosmetic surgeons and women make up 91% of patients undergoing cosmetic surgery.

GIRL POWER

The feminist drive for equality and empowerment has somehow gotten translated into “girl power” where equality is transformed into sexual aggressiveness in the media. It is difficult to argue that shaving one’s genitals, having breast implants, and pole dancing represents equality and empowerment. Yet for girls and young women this is the message from mainstream media. Female agency is co-opted by commercial representations where sex is used to power consumer demand. Consider the 145 million Bratz dolls that have been sold to preteen girls. These skanky dolls are marketed to six year olds and the junior version, Bratz babyz, to 3 year olds. They make Barbie with her anorectic proportions look down right wholesome. This isn’t just a method of imposing heternormativity on our children. No, this “sexualized too soon” message, what Sociologist Brian McNair describes as the “pornographication” of everyday life sells.

Kids in the United States are exposed to 8 hours of media each day. It is no wonder that girls as young as 6 ask their parents if they are too fat and complain that they are not sexy enough. This demonstrates how this phenomena compresses into childhood. Teachers report an increasing intensity of gender separation between young boys and girls with girls focused on princess culture and femininity and boy on fighting and violence.

Rosalind Gill, a lecturer in gender and media studies at the London School of Economics, has analyzed the way a woman’s sexuality is manipulated in contemporary advertising. Advertisements today represent the empowerment of women by showcasing assertive women who make a statement with their sexual power. Gill argues that we are witnessing a shift from sexual objectification to sexual subjectification, where women today are being presented as knowing and active sexual subjects. To deal with the fierce feminist attitude observed in young women who oppose being portrayed as sexual objects, the advertising world has stealthily constructed a new femininity, which is built around sexual confidence and autonomy. This new construct “girl power” lures those same young women to accept themselves as sexual subjects. The contemporary sexualized representations of women in media and popular culture, unlike in the past, does not depict women as passive objects but as desiring and glorified sexual subjects, so that that activities such as cleaning a toilet with a disposable brush, buying yogurt, and wearing stiletto heels are portrayed by media as self-actualizing personal choices. So instead of the lean, well dressed, apron clad homemaker greeting her suburban husband at the door with a home cooked dinner on the table, advertisements are now assembling the young, narcissistic, sexually assertive, “always up for it”, lean, tattooed, pierced woman who plays with her sexual power. Gill suggests that these images represent a shift from the objectification of women by the male gaze to the subjectification of women.

UNTOUCHABLE

Sandra Bartky, Professor of Philosophy and Gender Studies at the University of Illinois at Chicago has said “Feminine bodily discipline has this dual character: on the one hand, no one is marched off for electrolysis at the end of a rifle, nor can we fail to appreciate the initiative and ingenuity displayed by countless women in an attempt to master the rituals of beauty.” However, the standards for feminine appearance are becoming increasingly unattainable. For example the singers Christina Aguilera and Britney Spears during their pregnancies were featured on the covers of Marie Claire and Harper’s Bazaar respectively -literally and figuratively as new Madonnas. No woman could hope to emulate the perfection Photoshopped into these magazine covers.

Please watch the movie at: http://www.youtube.com/watch?v=hibyAJOSW8U

In return for access to celebrities, fashion magazines now routinely turn over complete control of the photography to the celebrity who employs design staff for the purpose of adjusting the images to their liking in the photographic manipulation program Photoshop as illustrated in this Dove Self-Esteem Campaign movie. Not only are the celebrities and models attractive in their own right, their photographs are retouched and their features enhanced. Yet their published images define sociocultural standards for appearance that many women feel they need to attain. This is also occurring with male models and celebrities but the social pressure is less intense for men.

This is what Naomi Wolf described as the “beauty system.” Second wave feminists have referred to women who attempt to discipline themselves to comply with the social norms of femininity portrayed in the media as “cultural dopes.” While it seems innocuous when a mother takes her daughter to have an ethnic nose refined by rhinoplasty at age 16, it is much more troubling when a mother takes her daughter of the same age to the plastic surgeon for breast augmentation or female genital cosmetic surgery. The American Society for Plastic Surgery reported that 18 and 19 year olds made up 3 % of all breast augmentation surgeries last year. Cosmetic surgery on children under 18 years of age constituted 5% of all cosmetic procedures in 2008.

EXTREME MAKEOVER

Wheeler Dixion writing last year in the Quarterly Review of Film and Video argues that the perfect body and face “is becoming the ultimate status acquisition of the 21st century.” One might ask if shows like I Want a Famous Face, The Swan, and Extreme Makerover have increased consumer demand for cosmetic surgery. Anecdotally, surgeons feel that they have. However, objective studies are harder to come by. Robin Nabi reported her study this year in the journal, Human Communication Research, that these shows, with the exception of I Want a Famous Face, are associated with a small increased interest in cosmetic surgery. I Want a Famous Face highlighted the risks associated with cosmetic surgery and viewing this show was associated in this study with an increased perceived risk of having surgery. Meredith Jones observes that these shows pull back the curtain on the “during” that is normally removed from before and after pictures.

Feminists have increasingly accepted that cosmetic surgery is not going away. Quoting Kathy Davis, a medical sociologist, who studies cosmetic surgery: “It opens the possibilities for biographical reconstruction and opportunities for women to redefine their sense of self.” Susan Paulson and Carla Willig writing last year in the Journal of Health Psychology found that the concerns of women ages 58 to 80 regarding their appearance are related to loss of social relevance and fears of disappearing. In contrast men of a similar age are more concerned with how they function. These women operate with a frame of mind that the aging body represents a mask over the inner younger identity. Some older women reject cosmetic surgery as too radical or dangerous. Screenwriter Nora Ephron in her collection of essays “I feel bad about my neck,” summarizes her concern about being overdone by plastic surgery writing: “ I learned the hard way that just because a doctor was a famous surgeon didn’t mean he had any gift for sewing people up.”

THE NEW NEW FACE

As boomers age, marketers have found glamorous aging celebrities to take up the cause of maintaining appearance. Actresses such as Diane Keton and Susan Sarandon were chosen for the L’Oreal Age Perfect campaign because it could be plausibly implied that they have maintained their appearance without cosmetic surgery. Whether they have or have not had surgery is irrelevant. Who needs surgery when a little Photoshop magic can make you look thirty year younger as can be seen when comparing magazine cover images of Sarandon with images taken at the same time without the benefit of Photoshop.

Meredith Jones in her article “Mutton cut up as lamb” notes that the emphasis on youth culture means a decline in the value of the elderly. In this formula, youth equates to beauty and aging to ugliness. She describes cosmetic surgery as an increasingly essential “toolkit” to maintain a stretched middle age or “agelessness.” This is what I call designer aging, a process eloquently described by Jonathan Van Meter in his August 2008 New York Magazine article where he define the “New New Face.”

Jones contends that women have only two choices: actual youthful beauty or youthful verisimilitude. Trying to appear youthful is almost as important as being youthful perhaps justifying surgical and non-surgical treatment effects that generously are idiosyncratic in their results or less generously hideously unnatural. Jocelyn Wildenstein, the socialite, or Orlan, the body artist, come to mind. Jocelyn is reported to have spent 4 million dollars on cosmetic surgery. Her late husband Alex was quoted as saying: “She seems to think that you fix a face the same way you fix a house.”

Please watch the movie at: http://www.youtube.com/watch?v=ri61lBfMBu0&feature=related

Some of our most notable celebrities appear engaged in this exercise. This perhaps helps us understand why individuals with surgically disfigured looks defend and appear to love their faces. I would suggest that for some individuals, the extreme alteration in appearance actually meets a narcissistic need for attention. We look at these individual with disgust, but instead of experiencing shame and humiliation, they experience attention and interest, which serves to confirm that they are objects of adoration. In the case of Michael Jackson, it now appears that his addiction to cosmetic surgery was also reinforced by the exposure to drugs administered for his anesthesia, contributing to his premature death.

COSMETIC SURGERY JUNKIES

This raises one final issue I would like to discuss with you. In considering my more demanding poly-surgery patients, I would like to suggest that there is a difference between body dysmorphic disorder and what Pitts-Taylor has described as “the surgery junkie.” The line between normal enthusiasm for the benefits of cosmetic surgery and cosmetic surgery addiction is not well defined. Body dysmorphic disorder is defined in the revised DSM IV as excessive preoccupation with a specific body part that causes significant impairment in functioning.

The cosmetic surgery addicts do not restrict themselves to a particular body part. Instead, they have a global appetite for cosmetic surgery. Like the painters of the Golden Gate Bridge who begin repainting the bridge immediately upon completing the last job, cosmetic surgery addicts are never satisfied and are only constrained financially in their quest for ever more enhancement. These individuals have surgery with many doctors and may not be forthright in disclosing recent procedures. I believe that this type of individual is more a victim of the neuroeconomics of appearance rather than some deep-seated psychological problem. Unattainable standards of beauty, the fear of loss of status, and the ready availability of cosmetic surgery all contribute to the problem. As such, cosmetic surgery addiction has more in common with drug addiction and pathological gambling than with body dysmorphic disorder. Unfortunately we are all familiar with the horrible disfigurement that seems to be the final common pathway for these individuals.

When does cosmetic surgery become too much? This is a question that we currently wrestle with as individual surgeons. However, I suggest that this is a public health issue. I ask you to consider that we may already be experiencing an epidemic of adverse cosmetic surgery outcomes. If surgeons can’t address this growing problem, we can look forward to solutions by angry legislators prompted by what will be the inevitable consumer backlash.

CONCLUSION

Socio-cultural pressures have elevated the standards of appearance predominantly for women. The difference between these standards and what people see daily in the mirror creates various levels of chronic shame. More than narcissism it is low self-esteem that drives the demand for cosmetic surgery. Cosmetic surgery is used as a survival kit to mitigate these negative emotions and personal insecurities. In the future, I hope to share my insights on shame mechanisms, attachment and terror management theory, mortality salience and the role of neuroeconomics in the cosmetic surgery, which ascertain the cultural concerns discussed in this article.

This article was given as a lecture before the 40th Anniversary Fall Scientific Symposium for the American Society for Ophthalmic Plastic and Reconstructive Surgery in San Francisco, California on October 21, 2009.

Why Doctor Steinsapir’s Microdroplet^TM forehead lift is different.

Ever wonder why doctors inject BOTOX® and Dysport where they do? Before Dr. Steinsapir, doctors never thought about how to control the spread of these agents.  Uncontrolled, these agents drift.  This means that using standard injections, there is no way to selectively treat the muscles that pull the eyebrows down and avoid treating the muscle that helps elevate the eyebrow.  Perhaps you have experienced these types of results yourself or have seen them in your favorite actresses: The forehead can’t move and the eyebrows drop like stones.  Think about it.  What looks good is a gently lifted eyebrow, no crows feet lines or brow pinch, and a forehead with reduced lines that is still able to move.  Imagine a BOTOX® treatment that allows you to have natural expressions! This is exactly what the Microdroplet^TM forehead lift does.

Microdroplet^TM means control.

Dr. Steinsapir has been treating with BOTOX® since 1988.  He has performed cosmetic BOTOX® treatments since 1992.  He developed the Microdroplet forehead lift by carefully listening to his patients.  The key break though came when he learn how to precisely target the muscles that pull the eyebrows down.  He accomplished this by using microliter injections of BOTOX® and Dysport® that are placed in such a way that the treatment can’t spread.  This means that the most important muscles that cause the unwanted pinching at the brow and crows feet, and pull the eyebrows down can now be treated with BOTOX® and Dysport®.  Before Dr. Steinsapir’s revolutionary break through method, it was not possible to treat these muscles without the risk of side effects.  Dr. Steinsapir can now safely perform a Microdroplet forehead lift without these concerns.  You will look years younger, refreshed, and relaxed without any evidence that you have had a service.

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As you can imagine, Dr. Steinsapir is immensely popular.  He is widely known not only for his patent pending Microdroplet^TM forehead lift, but also his much sought after Deepfill^TM under eye Restylane® treatment to correct under eye hollows and dark circles.  He was recently quoted in Harper’s Bazaar regarding these innovative non-surgical methods.  According to Dr. Steinsapir “The Zonelift^TM combines the Microdroplet^TM forehead lift with Deepfill^TM Restylane® for the undereyes and gives results that are better than what can be accomplished with surgery.” Only Dr. Steinsapir performs these services.  If you have been frustrated with treatments that never seem quite right, you owe it to yourself to learn first hand what Dr. Steinsapir can accomplish for you.  For a limited time, enjoy a complimentary initial consultation.  If you choose, have treatment at the time of your visit.

Contact us today, and begin enjoy the results you have been dreaming about!