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Extreme Cosmetic Surgery on the Rise

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Have extreme makeovers - combo face-lifts, tummy tucks, liposuction and more - left Hollywood and gone Main Street?

Apparently thanks to numerous prime-time television shows devoted to the world of personal cosmetic upgrades, plastic surgeons from across the country are reporting an increase in the number of requests for multiple operations, the type seen on popular programs like ABC's Extreme Makeover.

"I have seen an increase in the number of patients requesting multiple procedures over the last year," says Dr. Michael Olding, chief of plastic surgery at George Washington University Medical Center. Several other surgeons contacted by confirm the trend.

Not only are patients requesting more operations, they are increasingly particular about the exact procedures they want performed.

"Patients used to come to the office with a specific complaint, for example, 'I look tired,'" says Olding. "Now they request particular procedures, for example, 'I need a blepharoplasty [eyelid surgery], face-lift, and chin implant, and I was thinking about thigh liposuction.'"

Risky Business?

But even as more patients request more than one cosmetic procedure at a time, doctors are wary of the risks of performing several simultaneous surgeries.

"Many of my patients will ask for multiple procedures to be done at the same time. The key determinant about whether that should be done or not is safety," says Dr. John Anastasatos, professor of plastic surgery at the University of Alabama at Birmingham.

"As these are outpatient procedures and often done under general anesthesia, I don't like to exceed six hours of operating time," explains Anastasatos. "The risk of postoperative complications increases if one does so."

That's because general anesthesia has a strong effect on the cardiovascular system.

Among the dangers involved in multiple surgeries and long periods of general anesthesia are pulmonary thrombosis, which occurs when a blot clot forms in the artery carrying blood to the lungs.

"Furthermore, the longer the anesthesia time, the longer the recovery time is," Anastasatos adds. "Surgery and anesthesia both represent trauma to the body and its immune defenses."

But not all multiple procedures are problematic, and there are good reasons for performing some operations at the same time.

"If a surgeon can perform multiple operations on a patient at the same time there is some merit to that" acknowledges Anastasatos. "The patient will have to undergo general anesthesia once and recuperate from all at the same time."

Before and After Pictures

One reason for the increase in patient requests for specific, multiple procedures appears to be the TV programs' ubiquitous "after" pictures of smiling patients. Yet plastic surgeons view such images with skepticism.

"The media, including TV and magazines, often allow for misleading representations of what is efficacious and safe when it comes to plastic surgery," says Anastasatos. "Often there is misinformation."

Viewers' expectations run high when they see the quick results shown on television. "On Extreme Makeover, it is striking how limited the swelling and bruising is depicted," says Dr. Peter Rubin, eye plastic surgeon and professor of ophthalmology at Harvard Medical School in Cambridge, Mass.

"I suspect that some of the dressings are changed just prior to filming," Rubin adds. "Though this may make things more palatable for the viewer at home, it creates unusually high expectations from potential patients."

He adds: "Even in the best hands some of the more dramatic surgery that I perform may take two weeks or more before the planned 'overcorrection' settles into the desirable postoperative appearance."

One Step at a Time

In the face of that surge of interest, plastic surgeons are increasingly advising their patients of safer ways of performing cosmetic procedures, even when it means modifying their requests.

"We have an obligation to keep our patients' safety at the forefront," says Dr. Susan Obagi, dermatologist at the University of Pittsburgh Medical Center. "We, not the patients, should formulate a treatment plan that will give them the results they seek but in the safest manner possible."

Though performing multiple procedures may be good for business, Rubin says: "I do not think it necessarily serves the patients well in the long run. I feel that some of our patients are best served by doing several smaller procedures. Each procedure's outcome allows us to customize the next step, and achieve the best long-term outcome."

Tips for Patients

Patients considering cosmetic surgery needs to think twice about whether they really need the surgery, said Dr. Robert M. Wachter, professor and associate chairman of the department of medicine at the University of California, San Francisco. For smaller surgeries, such as chin tightening, the death rate is estimated at about 1 out of 100,000 surgeries, he said.

"[There's] nothing wrong with looking better, but you need to go in with your eyes open," Wachter said. "Even a 1 in 100,000 chance means that someone will be that one." To minimize your chances of becoming a statistic, do the following, he said: 1. Choose a board-certified surgeon and anesthesiologist. 2. Check on the number of procedures the surgeon and the hospital have done. 3. If you are having outpatient surgery, check to be sure the facility has a cardiac defibrillator, and ask about its procedures for handling a "crashing" patient. 4. Check to be sure the hospital follows appropriate guidelines to protect patients from blood clots, heart attacks and infections. This is mostly relevant to patients having bigger procedures than minor plastic surgery. 5. Check on the hospital's and surgeon's outcomes (mortality rates, post-op infection rates, return-to-OR rates) and compare to any published "benchmarks." 6. Get in shape prior to the surgery 7. If you smoke, stop for at least a few weeks prior to the surgery. 8. Show your doctors all your medicines, including over-the-counter products and herbal supplements. 9. If you choose to go ahead, realize that surgery is generally safe. Try to relax.

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