A Changing Face

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A Changing Face
November 25, 2007
By Jessica Wasmund
The Post-Journal

The words ÎÎplastic surgeryÌÌ do not often bring to mind images of wounded Doughboys fighting to stay alive as limbs were reattached by European surgeons.

Instead there is an image of Hollywood Û a sea of beautiful women with full lips, even fuller breasts and not a wrinkle in sight.

Yet over the years the face of plastic surgery has changed dramatically, one botox at a time, from its intended purpose of reconstructive surgery to its primary existence today Û cosmetic surgery.

ÎÎWeÌre really on the fourth generation of plastic surgery, presently,ÌÌ said Dr. Jeffrey Meilman, board certified plastic surgeon at Buffalo Plastic Surgery in Williamsville, N.Y. ÎÎThe first started during and after World War I Û men who were interested in reconstructing war-injured veterans. These were mostly European men from England and Germany. ThatÌs what plastic surgery started out to be Û just total reconstructive surgery.ÌÌ

The second generation, Dr. Meilman explained, began in the early 1940s. Reconstructive surgery became popular again with World War II veterans, but this group is the one that introduced the cosmetic aspect of plastic surgery. It was introduced in big international cities such as San Francisco, New York, Paris and London.

ÎÎThe first plastic surgery cosmetic procedures were really a mini-version of the face-lift and rhinoplasty,ÌÌ Dr. Meilman said.

The third generation, of which Dr. Meilman belongs, came in the Ì60s and Ì70s. This group was trained by the second generation, which consisted of 50 percent training in cosmetic surgery and 50 percent training in reconstructive. The last generation, from the 1990s to the present, Dr. Meilman believes places an emphasis on cosmetic surgery with a secondary view on reconstructive.

ÎÎNow because the insurance reimbursements, which really donÌt cover cosmetic surgery, a lot of other groups of surgeons have called themselves various types of plastic surgeons and theyÌve confused the landscape,ÌÌ Dr. Meilman said. ÎÎSo we have facial cosmetic surgeons, we have dermatological cosmetic surgeons and we have the group of general or plastic surgeons that IÌm talking about, that are the real plastic surgeons.ÌÌ

What sets the real surgeons apart is the years of training involved. A real plastic surgeon has four years of general surgery training after their internship and an additional two to three years of plastic surgery, making for a seven-year residency. The other group has a much shorter training period consisting of a two-year residency. Although that does not mean the other group does not to do a good job, Dr. Meilman said, there is a difference.

ÎÎMy most cynical aspect is over the last four of five years with ÎThe SwanÌ and ÎThe Great MakeoverÌ and all this hype about cosmetic surgery, everybody seems to be looking for the quick fix,ÌÌ Dr. Meilman said. ÎÎTheyÌre looking for procedures that in my opinion donÌt work or work very little. I donÌt believe thatÌs what most people want, they want something with real longevity. But when you read Allure magazine or other magazines, theyÌre all pushing injectable types of medicine that work for a very short period of time. TheyÌre pushing different laser-type treatments that work, but really very little. From my point of view as a plastic surgeon, nothing beats the knife and if theyÌre trying to get around that theyÌll eventually be disillusioned.ÌÌ

Dr. Meilman estimates that half the calls to his office are looking for maximum results with a minimum amount of effort. He says personally, he does not have such things to offer.

In terms of recovery time, a quick-fix operation has a much shorter recovery time than traditional surgery. While botox implants may take anywhere from one to four days to heal, the average tummy tuck or facelift will take a week or more.

Lara Kienle suffered from a deviated spectrum after her nose was broken, and as a teenager her primary physician suggested she have surgery to avoid breathing problems as an adult.

ÎÎThe surgery was extremely painful Û I wouldnÌt recommend it to my worst enemy,ÌÌ Ms. Kienle said. After the surgery, the healing process took about three weeks before she was back to normal. ÎÎI basically laid in bed for two weeks, I couldnÌt eat or move. Rhinoplasty is one of the most painful surgeries you can have, or so I am told, because itÌs such a focal point.ÌÌ

Even after everything has healed, she still suffers from frequent sinus infections as a result of the surgery.

ÎÎThe operation itself was fine, but the recovery process was very painful,ÌÌ Ms. Kienle said. ÎÎIÌm glad I had it done, now that itÌs over, but I would not willingly go into it again.ÌÌ

Most reconstructive surgery is major burn reconstruction, children born with cleft lips or pallettes, hand reconstructive surgery and some tumor defects. Dr. Meilman said there are fewer of these instances today because workplaces have become safer, with the exception of cleft lips, because one in 1,000 children in the world are born with the defect. As for tumor reconstruction, most of those types of problems are caught early on so they are rarely seen with adults.

ÎÎGenerally reconstructive surgery is covered by insurance, while most cosmetic surgeries are not covered no matter what the company is,ÌÌ Dr. Meilman said. ÎÎFor breast reconstruction after a mastectomy, itÌs now nationally mandated by law that insurance companies cover these women. That was a long fight between plastic surgeons and insurance companies, and thatÌs the way it is presently.ÌÌ



?Cosmetic Surgery Today?

Initially when the make-over television shows premiered, a large number of people flooded plastic surgery centers across the country. Additionally, people will occasionally come in requesting certain celebritiesÌ features, such as lips or cheeks. However, Dr. Meilman said this not a common occurrence, and those people are easy to spot. He says it is important to pull them aside early and tell them just because they want someone in particularÌs cheeks, does not mean they will look like them.

ÎÎI would say quick-fix methods are effective for people in their 30s or early 40s, but thatÌs it,ÌÌ Dr. Meilman said. ÎÎThey are not going to work for somebody in their 50s, 60s, 70s or 80s. Those people are dreaming.ÌÌ

Nowadays, he feels cosmetic surgery is more acceptable. They are no longer harmful or life threatening, and people who want to do it will.

ÎÎHowever, a lot of these procedures are real surgical procedures Û theyÌre not meant to be done in an office,ÌÌ Dr. Meilman said. ÎÎA lot of these are meant to be done in a hospital, and so long as theyÌre done in a proper place I believe people will be safe.ÌÌ

Dr. Meilman also referenced the recent death of Donda West, mother of rapper Kanye West, who died after cosmetic surgery.

ÎÎIf you read between the lines, you see she had eight hours of surgery and was sent home Û that kind of stuff is ridiculous and shouldnÌt be done,ÌÌ Dr. Meilman said. ÎÎIf youÌre having a lengthy procedure done in a hospital you stay overnight or you stay five nights until youÌre fine and you can walk out. ItÌs when you start cheating the parameters of whatÌs reasonable you start looking for trouble.ÌÌ

He feels that in terms of national attention to plastic surgery, it will continue to increase every year. However, because of the declining local population Dr. Meilman does not forsee as much growth in Western New York, with the exception of spas and easy treatments.

ÎÎStandard procedures such as facelifts, rhinoplasty, tummy tucks breast augmentation have all been around for 50 years or more so they are not experimental procedures anymore,ÌÌ Dr. Meilman said. ÎÎThey should have standard results Û some people will have better results than the standard while some will have worse. Those mini-type things I think are mostly a passing fad. For example about 12 or 15 years ago something called the Co2 Laser was en vogue Ò you could laser your whole face and get rid of the wrinkles. Well itÌs hardly done anymore because it was such a horrible recovery period. They had problems with it and they learned, and it simply isnÌt done anymore.ÌÌ

He feels some of the procedures available today, such as FLAXEL, have no real longevity to them. Injectable medicines have shown improvement over the years, he says, but even those still only last six months to a year. Today the two most popular procedures are botox and lyposuction. Botox generally lasts about four months before it needs to be repeated. Lyposuction, which is the most commonly preferred surgical procedure in the world, is here to stay, Dr. Meilman believes, because it shows permanent results.

However, with the ever-increasing number of procedures available, more and more people are going under the knife or opting for a quick injection.

ÎÎEveryone has flaws and itÌs understandable to try and fix them, but you have to know when enough is enough,ÌÌ Ms. Kienle said. ÎÎI think everything is OK in moderation, but unfortunately some people canÌt keep it in moderation and they give plastic surgery a bad name.ÌÌ

As for the future of plastic surgery, Dr. Meilman believes it will only continue to grow.

ÎÎI think years from now, plastic surgery will increase in popularity,ÌÌ Dr. Meilman said. ÎÎI go around the world doing different surgical procedures. In South America, all cosmetic surgery is totally covered by the health care system, because they believe it is a normal part of taking care of yourself. Brazil, Cuba, Venezuela, itÌs just as standard as going to the dentist. But will that philosophy come to the United States, I just donÌt know.ÌÌ