The ABC's of plastic surgery:
Debunking myths about cosmetic surgery.
By Dr. Mathew C. Mosher

It’s been interesting to watch the evolution of drmosher.com. The original concept was to provide accurate, relevant information to my clients. The explosion of accessible information in the past decade has been nothing short of amazing. Information sources on cosmetic surgery have grown enormously and haven’t outpaced the appetite for knowledge.

While many people realize the importance of educating themselves to more effectively sort through this maze of information, it’s become increasingly difficult to determine fact from fiction.

It’s now common to see exaggerated claims about cosmetic surgery and esthetic services. Patients seem all too willing to believe what they would like to believe rather than what is reality. As a plastic surgeon specializing in cosmetic surgery and related services, I felt it was my job to help educate patients about the realities and expose the myths.

Another interesting evolution has occurred within my practice during the past few years. Most clients come to my office in search of fast solutions to make them feel better about the way they look. A common motivation is a sense of imbalance between the way they feel inside and the way they view themselves on the outside. We can all relate to this in some way. There’s no question in my mind that restoring this balance is powerful and justified. But while having surgery or even a non-surgical enhancement such as Botox Cosmetic™ might be helpful, it’s often only a small part of achieving this balance. Changes to our appearance can reflect our lifestyle and personal choices. Often it makes more sense to combine surgery with lifestyle changes to enhance the results of the procedure in the long run.

Let me give you some examples of what I mean.

Most people think of cosmetic surgery as a quick fix: “ I want a smaller nose” or “I want larger breasts.” These patients are hoping cosmetic surgery can correct their appearance problems and allow them to carry on their lives without the burdens of external features that bother them. Having physical balance and harmony restored to their appearance through cosmetic surgery can be extremely rewarding for patients. An experienced plastic surgeon possesses the skill to achieve this.

But many of the appearance changes my patients ask me to correct are inseparably linked to their lifestyle choices and to natural aging. They say, “My thighs are too big” or “There are bags under my eyes” or “I have sagging and wrinkles that make me look old.” Patients who make these comments can improve the quality and enhance the longevity of their surgery results by improving their healthstyle. You already know smoking and sun exposure damage skin and cause it to age prematurely. Poor eating habits and lack of exercise promote a body shape that screams for cosmetic surgery. As a physician, I encourage lifestyle changes to assist the results of cosmetic surgery or, in some situations, eliminate the need for surgery altogether. During discussions with patients about the importance of lifestyle modifications, good nutrition and stress management, I generally find one of two responses.

The first is usually what I’ll call the common “Don’t need to hear it doc” approach. Many of us don’t want to change our lifestyle or certainly don’t want to be told to change it. Some do not believe changes are worthwhile or they have tried to improve things on their own and for some reason, it just didn’t work for them.

The second response to discussions about lifestyle changes is something like “Tell me more doc.” drmosher.com was created for this group in particular.

It’s the mission of this magazine to educate you about what you can do to achieve the optimal balance of the way you look and the way you feel. I’ll share with you some of my knowledge about cosmetic surgery and non-surgical treatments that can enhance your appearance. With the help of our expert contributors to the magazine, I hope to empower you to make personal changes to improve the quality of your life, enhance the results and longevity of your surgical procedures and slow down outward and inward changes due to aging.

In my practice of plastic surgery I get a lot of questions about cosmetic surgery and related treatments. Some of these questions are prompted by a genuine lack of knowledge. The rest come from confusion due to the misinformation readily available. In this issue of drmosher.com you can learn from our expert contributors who also deal with misconceptions related to their areas of expertise. Here, I’ll address some of the common myths occurring in my practice and have chosen examples across the range of the services I offer.

Myth #1: Liposuction is a good solution if I can’t lose weight.
This thought motivates many patients who seek liposuction. It is certainly tempting to use liposuction to achieve a fast improvement in your shape or, as some patients often put it, “Once I have liposuction I will be more motivated to exercise and change my diet.” If this sounds familiar, you are not alone.

The problem with this approach is that it is doomed to failure. The fat deposits on the outside of our bodies that bother most of us are determined by a variety of different factors. There are predetermined genetic components, such as the fat distribution patterns associated with gender and family traits. Medical factors, such as illness of the endocrine system (including hypothyroidism or diabetes) or prescription medications (like Prednisone) may influence fat distribution.

However, diet and exercise remain the most important factors for modifying fat distribution. The good news is they are under your control.

Liposuction is best performed in patients who are already near their ideal body weight, have maintained their weight for several months and have established healthy nutritional habits with regular exercise. In this case, we can use liposuction to contour the outer fat layer and achieve a better shape with the high expectation the patient will maintain those shape improvements permanently. During liposuction, only some of the fat cells in the treated area are removed. The remaining cells continue to behave the same way they did before surgery. Although adult fat cells usually do not multiply, they can enlarge without limitation. Consequently, if the medical or environmental factors that created the problem in the first place don’t change, the remaining fat cells grow and the shape improvements achieved with surgery diminish or disappear.

In summary, liposuction is not for treating obesity. It’s for sculpting the outer fat layer of problem areas in healthy, fit people. If you are having trouble achieving a healthy weight then do not hesitate to get professional assistance.

Myth #2: Cosmetic facial surgery is best done when I’m older with lots of sagging and wrinkles.
A lot of misunderstanding exists regarding the best time to have cosmetic surgery. In the past, facial cosmetic surgery involved procedures designed to lift and tighten the skin. These older procedures produced predictably poor results for two reasons.

The first is that changes in the face due to aging involve a complex combination of factors. These factors include not only the loss of tone in the skin but also processes such as loss of subcutaneous fat, stretching of ligaments and muscles, loss of bone, and the gravity-mediated descent of facial structures.

The second reason old-fashioned tightening had poor results is because the longevity of changes produced by surgery depends on the qualities of the repositioned tissues. If the skin, ligaments and muscles have lost their natural tone and elasticity, no amount of tightening these tissues will create a lasting result. Not surprisingly, older “facelift” techniques relying on pulling the skin tight did not restore a youthful look as much as they created a different, albeit smoother, look. When facial cosmetic surgery is performed on healthier tissues, the results of surgery will last longer.

Another important consideration is the more severe the age-related changes are before surgery, the more obvious, and therefore dramatic, the changes from surgery will be. This is usually acceptable but should be considered if a patient is concerned about others knowing about the surgery.

By having surgery performed at an earlier stage you can maintain your youthful look, rather than waiting until you’ve lost it. In my practice, the average age for a woman to have a facelift is around 50 years old, in a range from 38 to 80. Younger patients are requesting eyelid and brow rejuvenation surgery all the time. Newer techniques minimize recovery time and keep the surgery private. The only people who need to know are the ones you choose to tell. If you already have changes due to aging, then make sure your surgeon is capable of delivering natural-looking results that don’t rely on tight-looking skin. Improving your general health and skin health before surgery gives you the best opportunity of enjoying the results of facial cosmetic surgery for years to come.

Myth #3: Plastic Surgery does not leave any scars.
This myth is surprisingly prevalent and comes up almost daily. Any surgery involving an incision through the full thickness of the skin leaves a scar. A scar is the natural response of the body to injury and cannot be avoided. However, plastic surgeons have the skills to make these scars as minimal as possible. Scars are placed in discrete locations or positioned in a manner as to make them more difficult to see.

Some surgeons perpetuate this myth by making false or misleading claims. An example is “scar-less” or “no-scar” breast augmentation surgery. This is not what the consumer would be led to believe but simply means the incision scar is not on the breast. The scar is very real and is located in the armpit or the belly button for this operation.

Further confusion occurs when misguided marketing promotes the use of lasers instead of scalpels, or tissue glue instead of stitches, suggesting a better result.

Very simply, there’s always a scar with surgery. Although a large component of how a scar looks is not within the control of the surgeon or patient, a skilled surgeon can minimize the visibility of surgical scars and should discuss these strategies with you prior to surgery.

Myth #4: Lasers produce better results.
An almost magical aura surrounds the use of lasers. They are truly amazing instruments and are used in a variety of surgical procedures. Some patients mistakenly believe surgeons who don’t use lasers are just not staying current.

Lasers and intense pulsed light (IPL) machines have led to tremendous advances in plastic surgery and many medical specialties. Light energy from these devices can be focused on targets of varying color and composition. This light energy is then absorbed by a target in the tissue and causes a transition of light energy to heat energy. This heat is used to burn the target to achieve the desired results. On a microscopic level, the injury to the tissue caused by this heat is not very different from the injury caused by the trauma of a scalpel.

In carefully controlled experiments, scars caused by lasers are no better than those caused by scalpels. The real advantage of lasers is that, in some cases, they can selectively injure tissues more accurately than is possible with traditional surgery.

A good example of a unique use of laser is for the removal of tattoo ink (see our tattoo removal feature in this issue). In my practice I use lasers for non-surgical applications such as laser hair removal and skin rejuvenation. Knowing how and when to use lasers for optimum results and safety requires excellent medical judgment that comes only with experience and specialty training.

Myth #5: With all of the advances in non-surgical treatments, cosmetic plastic surgery is no longer necessary.
This remains a myth but these advances have added to the range of treatments available. Some surgical procedures are now rarely performed because of developments in non-surgical methods.

Dermabrasion surgery was frequently used in the past to treat facial scarring. Today, facial scarring is now almost always treated with laser resurfacing and other gentler non-surgical procedures like chemical peels and microdermabrasion.

Rather than replace surgical treatments, non-surgical treatments compliment them. Sometimes these procedures are viewed as “introductory” procedures and can delay the need for surgical intervention. These new treatments have allowed younger patients to begin having procedures to diminish the signs of aging or delay their onset.

You should not view these treatments as “simple” and without risk. They still require skilled judgment to choose the appropriate treatment and a proper consultation in a medical environment.

These advances include the use of Botox Cosmetic™ to control unwanted facial muscle activity, fillers for facial creases and depressed scars, lasers to improve skin appearance and skin care to optimize your skin health. Patients have a large selection of treatments to choose from and need detailed advice to make the right decisions to achieve their goals. These less-invasive procedures have greatly improved our ability to tailor treatments to meet patient needs. Plastic surgeons can now individualize the treatments to address the esthetic goals, the tolerance and ability to manage post-treatment recovery time as well as finding solutions to work within the budget of all clients.

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