Cosmetic surgery

Overview

Cosmetic surgery aims to improve how people look and feel about themselves. It can be performed on just about any part of the face or body. Many people who choose this type of surgery hope it will boost their self-esteem. Another name for the field of cosmetic medicine is aesthetic medicine.

Why it's done

Cosmetic surgery can bring lasting and dramatic changes to your appearance. It's important to understand how those changes might affect the way you feel about yourself. Before you go to see a cosmetic surgeon, think about your reasons for wanting to change how you look.

Cosmetic surgery might be right for you if you:

• Have realistic expectations about what surgery can achieve and the difference it could make in your life.
• Understand the medical risks of surgery, the physical effects during healing and the lifestyle changes that may be needed during recovery.
• Are fully aware of the expenses involved.
• Have any long-term medical conditions under control.
• Don't smoke tobacco. Or you're willing not to smoke or use nicotine products for 4 to 6 weeks before surgery and 4 weeks afterward. Nicotine products include patches, gums and lozenges.
• Have had a stable weight for 6 to 12 months, for certain cosmetic procedures.

Risks

All surgeries, including cosmetic procedures, come with risks. If you have obesity or diabetes, you might be at higher risk of complications. Complications can include trouble with wound healing, blood clots and infections. Smoking also raises risks and slows healing.

Before your procedure, you meet with a healthcare professional to talk about these risks and others that may be related to your health history.

Medical complications that can happen with any surgery include:

• Complications related to anesthesia, including pneumonia, blood clots and, rarely, death.
• Infection where the cuts during surgery, called incisions, were made.
• Fluid buildup under the skin.
• Mild bleeding, which may require another surgery.
• Heavy bleeding, which may cause you to need blood from a donor.
• Scarring.
• Separation of the surgical wound, which sometimes requires more surgery to fix.
• Loss of feeling or tingling from nerve damage, which may be permanent.

How you prepare

Questions to consider before pursuing cosmetic surgery:

• What are my reasons for wanting to change how I look?
• What are the specific parts of my appearance that I want to change?
• Am I being realistic about the results that I expect to get from the surgery?
• What aspects of my life might be affected, such as family, work, travel and social commitments?
• Will I have to have a caregiver help after surgery?
• Is this a good time in my life to have cosmetic surgery?
• Have I talked about my concerns and questions openly with my healthcare professional?

Questions to ask the cosmetic surgeon:

Be ready to write down the answers to the following questions. Bring a family member or close friend to your appointment if you can, so you don't miss anything.

• What can you tell me about your professional experience and education?
• Are you board-certified? If so, how long have you been board-certified?
• Were you trained in this specific field of cosmetic surgery? How many years of training did you receive?
• How many times have you done the procedure that I'm thinking about getting?
• Where and how would you do the procedure? Do you have hospital privileges to do the surgery?
• What other healthcare professionals will be involved in my care?
• What results can I expect? Can you show me before-and-after photos of people who've gotten this type of surgery from you?
• In general, what are the risks? Are there risks unique to my health history?

Questions to ask about a procedure:

• What does the procedure do? What does it not do?
• Is this the right treatment for me? Are there other procedures I should think about getting instead?
• What types of anesthesia are available to prevent pain during surgery?
• What risks and complications are linked with this procedure and the anesthesia?
• How long might it take me to recover from the surgery?
• Can I expect much pain? How would you help me manage the pain?
• Will I have any scars? If so, what will they look like?
• If my procedure requires stitches, when will they be removed?
• What kind of limits on activities will I have after surgery?
• How long before I can go back to my regular routine?
• How long before I see the final results of my surgery?
• How long will the results last?
• How much does the procedure cost?

What you can expect

Make sure you have a clear understanding of what will happen before, during and after the procedure. It's also important to know what results to expect. Many physical features can be successfully changed. Others cannot. The more realistic your hopes, the more likely you will be pleased with the results.

Before the procedure

Your surgeon explains how cosmetic surgery can change your body and what you can expect as a result. This is a chance for you to talk about what you hope to achieve with surgery. It's important to learn what your options are and what the outcome of surgery might be. That information can help you make the best decision.

Your surgeon likely will tell you about specific procedures, what to expect, the benefits, risks and possible complications. You also might be told about other types of surgery. The surgeon may recommend more procedures to enhance your overall result.

Your surgeon likely will talk with you about the concept of asymmetry. It means that one side of the body naturally looks different from the other. For example, look at all the small details on the back of your hands. There are natural differences between the two. Your surgeon tries to make your result as symmetric as possible. But perfect symmetry is not realistic.

Your surgeon also likely will explain the concept of balance. Changing one part of the body may affect your overall appearance. For that reason, more surgical procedures may be needed to bring greater balance.

Health review and instructions

You also may meet with a nurse or another member of your surgical team to review the medical forms that you filled out and ask general questions about your health. Any medicines or supplements you take are reviewed as well. You're also asked about lifestyle issues, such as whether you smoke.

Your healthcare professional reviews what you can expect after surgery. This includes pain, medicines, diet, activity and work restrictions. You'll likely also talk about details such as the need to arrange for a ride home after the surgery. A professional in the surgeon's office called a patient coordinator also may talk with you about some of these details.

It's important to follow the directions your care team gives you. That can help minimize the risks and complications of surgery.

Consent forms

You're asked to sign a consent form that shows you understand the risks of your surgery. The form also confirms that you understand the risks of medicine to prevent pain, called anesthetics. You may be asked to sign a consent form so that photographs can be taken before and after surgery. Photographs serve as a reference for the surgeon during the procedure. They also become a part of your medical record.

Estimate of costs

You'll be given an estimate of surgical fees. Insurance doesn't cover cosmetic surgery. In general, payment is needed before surgery.

Physical exam

You might need a physical exam to check your general health before cosmetic surgery.

During the procedure

Various types of medicine are used to prevent pain during cosmetic surgery. The type that's right for you depends partly on the procedure and on your health. These medicines include:

• General anesthetics that put you in a deep sleep-like state.
• IV sedation, which relaxes you and sometimes puts you in a sleep-like state.
• Regional anesthetics that prevent pain in a large part of the body while you stay awake.
• Local anesthetics that prevent pain in the part of the body being operated on while you stay awake.

These medicines are given by a doctor called an anesthesiologist.

Some types of cosmetic procedures need to be done at the hospital. Others can be done at the doctor's office, such as injections of facial fillers.

After the procedure

Once you go home after your surgery, follow any instructions your surgery team gave you, such as:

• Instructions for self-care after surgery, which are specific to your procedure.
• Medicine instructions and prescriptions, such as for pain medicines and antibiotics.
• Recommendations on how soon you can get back to your usual activities.
• Contact information for your surgery team if you have questions.

Results

Despite being informed and prepared, you might be surprised by the bruising and swelling that follow cosmetic surgery. You may notice the most bruising and swelling 1 to 2 weeks after surgery. It might take months for the swelling to completely go away.

While you recover, you might feel sad or in low spirits at times. But try not to judge the results of your surgery too soon. Call your surgeon's office if you have any questions or concerns.

Realistic expectations are key. The goal is improvement, not perfection. Each person will have a different result. Keep in mind that:

• Bruising and swelling go away over time. Surgical scars are permanent.
• Recovery times vary by person and procedure. For some procedures, it can take up to a year to see the final results. An example is surgery to change the shape of the nose, called rhinoplasty.
• Follow-up surgeries may be needed to achieve your goals.