Plastic surgery

Plastic surgery
 

Slide your curser over the image and click.

 
   
The breasts The face The tummy The hips The legs The thighs
  Plastic surgery
Français  English
   

 

 

       
      FAQs
   

 

Is Plastic Surgery the same as “other” operations?

Who is qualified to operate during Plastic Surgery?

Is it true that Plastic Surgery is expensive?

Is it true that Plastic Surgery doesn’t always “work”?

Is Plastic Surgery dangerous?

Who can go and have Plastic Surgery?

How to go about it?

How to choose a Plastic Surgeon?

Should one be ashamed of having Plastic Surgery?

.............................................................................................................

Is Plastic Surgery the same as “other” operations?

Plastic and Cosmetic Surgery derives directly from Reconstructive Surgery. Little by little and more and more often, the techniques that were employed to rectify natural or accidental physical deformities that were either due to traumatisms, accidents or to certain illnesses, were also employed to alter the shape of a face, of a nose or of breasts.

For a long time, Plastic Surgeons were at first trained in the more traditional form of surgery. These newly experienced surgeons would then operate in their specific fields for some time and then often by chance turn to Aesthetic Surgery. Though the practitioner would be fully aware of the existing exceptional technical values, general opinion often had it that he placed himself on the outside of the other more “honourable” surgical specialities.

Next, they had to cope with the suspicion in which Plastic Surgery was held by some of the general public, particularly as more and more daring techniques were developed and that a larger part of the public was getting to know it.

Nowadays, Plastic and Cosmetic Surgery has finally been accepted as more and more people acknowledge the right to change one’s appearance. During the public’s change of opinion, the Medical professional created a well-defined Surgical Speciality in Plastic, Cosmetic and Reconstructive Surgery. It now forms part of every young Doctor’s programme and offers the possibility of eventually choosing this speciality. In France, it is no longer possible to claim to be a Plastic Surgeon without having been accepted as a qualified member of the « Conseil de l'Ordre des Médecins”. This is the French National Medical Society which also legislates and monitors the Medical Profession.

For the practitioner, Plastic Surgery is like all other surgeries though at the same time it is quite different. It is similar because the practitioner who wishes to work as a Plastic Surgeon must have followed the necessary programmes to qualify as a Medical Doctor specialised in Surgery. Different because he will need to have followed a specific programme with theory and practice in order to make it his profession.

Yet, there still remains one more fundamental difference between Aesthetic Surgery and the other specialised Surgeries: the Patient. In other specialities the patient is considered ill (in other words recognised as such by the local health authorities: in the U.K. the NHS and in France the Sécurité Sociale) whilst in Aesthetic Surgery he is not considered ill. Consequently, as with all medical visits that are not covered by public insurance, the patient pays for the operation.

...........................................................................................Top of the page


Who is qualified to operate during Plastic Surgery?

Curiously, in France, where the Government is placing all its efforts to create a proper judicial framework for Plastic Surgery and this to better protect the patients, all French qualified M.D.s are authorised to perform surgical acts, including in Plastic Surgery. But at the same time, the Council of Surgeons (le Collège de Chirurgie) recognises that there exists a specific specialisation for Plastic, Cosmetic and Reconstructive Surgery, whilst the “Ordre des Médecins” oversees the qualifications and experience of each individual practitioner and has the authority to hand out a specific certificate that recognises the subject qualifications: the practitioner is then seen as skilled in the practice of Plastic Surgery.

So, to answer the question: all French Doctors have the right to perform an aesthetic operation. But….

A dermatologist would never even think of operating on a hip prosthesis, and a short-sighted person would not dream of seeing a Gastroenterologist for his sight. The various specialities in the medical profession that have become more developed and the specific training programmes that take place over a number of years do not allow one specialist to interfere in another speciality. Practically, because out of the 5000 practitioners that practice Plastic Surgery, only 13% of them have an ad hoc qualification. That is not to say that those who do not have this qualification do not know how to operate. Far from it. The one operation in Plastic Surgery that is the most carried out in the world, liposuction, remains a surgical procedure that is quite elementary and without major risk. In fact the real difference between two practitioners lays in the perception that each one has of the aesthetic operation. The specialist is fully aware of the psychological factors involved and because he is exclusively specialised in Plastic, Cosmetic and Reconstructive Surgery he knows instinctively how to fully satisfy the patient. The Plastic Surgeon knows full well that he is not only modelling a body, but also the patient’s self awareness. The Plastic Surgeon does not only face a case, but also the patient’s wish, more or less uttered, and as a specialist he has the unequalled techniques and experience to carry them out.

The practitioner does not only carry out a specific service; it is quite possible that with the same request coming from the same patient, two practitioners would not carry out the same surgical act. This means that it is a little bit like being a Pygmalion: Plastic and Cosmetic Surgery is not quite the same as other surgeries, and the Plastic Surgeon is not quite the same as other Surgeons.

Lastly, it must be said that only a qualified Plastic Surgeon is trained to deal with the post-operative risks that exist after any Plastic Surgery. In other words, he is highly apt at taking responsibility after the operation, of discovering any anomalies and is therefore capable of reacting accordingly.

...........................................................................................Top of the page


Is it true that Plastic Surgery is expensive?

It is true that, due to the many different specialties that are involved in a surgical act (surgeon, anaesthetist, and nurses at the operating block) and the technical equipment that is necessary, all surgical acts are costly.

In comparison with a general surgical act, Plastic Surgery is not more expensive, but the costs incurred by the doctors, surgeons and anaesthetists, and the clinic are not reimbursed. Therefore it is the patient and private insurance that pay for the operation. Generally, the clinic’s invoice is either made out directly to the patient or to the surgeon. The same applies to the anaesthetist. Implants and or prosthetics are also directly invoiced to the patient. In the case of a hospital stay, it is individual to the patient whether the services are more or less prestigious, though the practitioner determines the minimum stay whilst maintaining maximum security. It is also quite normal that the practitioner is responsible for any exceptional exceeding costs.

To finish, the surgeon’s estimate is always presented at the first visit and both parties agree on it. The cost refers to the act, the technique that is put in place, the materials that are used, the assistance needed, and lastly the surgeon’s notoriety. Contrary to what most people think, in the vast majority of cases, the cost involved for each particular operation does not vary from one surgeon to another. People are increasingly more aware of prices and so this does not allow for excessive pricing.

Since January 1997 in France, the legislation compels the Plastic Surgeon to present a complete detailed pricing of the surgical act (anaesthesias, materials, fees, etc.) to the patient and enforces a 15 day reflection period between the first visit and the actual date of the operation.

For more clarity and to be more precise, the real question should be: “is the cost of Plastic Surgery worth it?”… In fact, something can be very expensive as soon as it no longer satisfies us. The same applies to Plastic Surgery. If the patient is dissatisfied with the results, or if he learns that he could have had the same operation at a lesser cost, then yes, it can become “too expensive.”

...........................................................................................Top of the page


Is it true that Plastic Surgery doesn’t always « work »?

Contrary to heart, vascular or general surgery, Plastic Surgery’s patient can see whether the operation has been successful or not. As in this case it is the patient who wishes to alter his body or face, it is therefore difficult to imagine someone asking the Cardiologist to change his Mitral Valve as it is no longer impermeable!

Because the patient is more or less aware of what is wrong with him, he can see for himself if what he has asked the surgeon to do has been successful. Disappointments can happen, and these can be completely justified or even subjective, particularly in the case of a patient who is unhappy even though the operation was surgically successful. In the case of the Cardiologist’s patient, he is unable to see whether the operation was well done (though it is practically always successful) and therefore he can not be subjective. The act remains essentially technical, and the beauty aspect of it is of no concern.

In other words, in the case of Plastic and Cosmetic Surgery there are a number of people that can appreciate the surgeon’s work. And this literally. These are, of course, the surgeon, the patient, the patient’s family and friends, etc. multiplying the number of opinions. How many of them are capable of judging whether a cholecystomy or gall bladder removal has been properly done or not? So, this is probably where Plastic Surgery got the reputation of not always “working”.

Nowadays, the techniques employed in Plastic Surgery have been thoroughly tested. The practitioners, perhaps more so than other surgeons, never improvise and are fully competent due to the selective and complete training courses that they are made to follow.

In conclusion, Plastic and Cosmetic Surgery ‘works’ nearly 100% of the time providing the patient and the surgeon have fully understood each other before the operation, i.e. the goals, the surgery’s limits, its plausible results, but also the patient’s real motives.


...........................................................................................Top of the page


Is Plastic Surgery dangerous?

On general, Plastic Surgery includes a multitude of different surgical acts. They go from very simple ones to very complicated ones, but you must remember that no operation remains innocuous. The same legal rules of deontology apply to Plastic Surgery as to any other surgery. And yet, all surgical acts carry a risk and the practitioner, as all Doctors, must avoid to the best of his knowledge all unjustified risks. (Article 40 of the French Medical Deontology Code/decree No. 95-1000, 6th September 1995).

There are three areas where there could be risks: the anaesthesia, the surgical act itself, and finally post-operative.
The risks from anaesthesia vary on the type of anaesthesia used, though the risks are higher with General Anaesthesia. The visit to the anaesthetist prior to the operation considerably reduces these risks, though there can be unpredictable causes, due to the anaesthesia itself and to which the body can react to. In the vast majority of cases, these products are perfectly tolerated though a minimal intolerance to the chemical substances can be revealed during the three phases of a general anaesthesia. These are: sleepiness, the surgical act and the waking period followed by the immediate post-operative period.

For example, as sleepiness starts settling in one of the most dangerous and unpredictable risks is the anaphylactic shock. This is a violent reaction to the chemical substances that are injected and that in case of an allergy to one of them can lead to death in minutes if left untreated. This brings us to the reasons why it is important to have the operation in a proper medical-surgical environment. (This incident can also happen, to a lesser extent when a medication is taken).
A cutaneous reaction can also be observed, though this presents no real danger as long as they are isolated cases and are under surveillance. The same applies to blood pressure, the respiratory tract and the heart, as it is very important that these are under the anaesthetist’s surveillance throughout the entire surgical act.

The waking period comes at the end of the surgical act. Pain can be a risk factor, particularly if not taken properly into account. It is indispensable that the patient remain under constant surveillance as he slowly regains consciousness and as the anaesthesia slowly disappears. The patient could go back to sleep, which would be dangerous without respiratory assistance. In the olden days nausea and vomiting were patients’ worst nightmares, but nowadays these are very well controlled.

If the surgeon is experienced in the technique that is used there are relatively few dangers and if there is a risk, it is usually because of a misplaced gesture which can happen if the surgeon encounters an anatomical anomaly. The post-operative phase is more delicate. In fact, as the body slowly goes back to normal other incidents can take place: such as bruising, partial paralysis and infections. But, later on, two to three weeks after the operation, there may be another risk: the patient’s dissatisfaction, objective or not, to the aesthetic results.

Apart from that, Plastic Surgery remains just as safe but also just as dangerous as any standard surgical act, though it may have that slight advantage that the patient does not suffer from any particular illness.

...........................................................................................Top of the page


Who can go and have Plastic Surgery?

Said like this, the answer is clear: everybody. However, each case must be examined individually in order to deliver a correct assessment.

We have said that Plastic Surgery is like all the other surgeries. Anybody can have appendicitis, just like anybody can decide tomorrow that their nose no longer pleases them. Worse, everybody ages and therefore is submitted to the changes that come with age.

In fact, some contraindications do exist that belong solely to what is being asked and to the patient’s health. You must not forget that the surgeon has to satisfy his patient’s request. There are some pathological cases that come to mind when the patient asks to have the physique radically altered through surgery. In other words, whatever the act is, it is only effective on the symptoms never on the cause. The patient may go from Plastic Surgeon to Plastic Surgeon, and become what is commonly known as a ‘multi-operated’ who is never satisfied. If this is the case, it goes without saying that surgery is to be avoided. The Surgeon must listen carefully to the patient and if what is wished for seems disproportionate to what will change then he should reconsider the request. A similar situation can arise with young adolescents who are in the process of changing and are going from childhood to the status of a young adult. During this period a load of uncertainties and insecurities can lead to the wish of ‘creating’ a new self. On top of it, some operations are not recommended because of their young age and the fact that full growth has not been achieved. This is the case in ear surgery, the operation that reduces large ears. Children under the age of 7 should not be operated on. This is also the case in breast implants, for the same reasons: the young girl has not finished growing. On the other hand, some Cosmetic surgeries can be beneficial to these youngsters as is the case with Rhinoplasty (Nose Surgery) or even in the case of breast reduction.

The counter indications that lie within the medical profession are very rare, though there are a few. In somebody that is too old or with a past history of cardio-vascular disease, the anaesthetist can refuse to treat the patient so as to avoid him taking an unnecessary risk. We are talking about an operation that is not vital to the patient’s health. At present, pregnancy can delay the surgical act, as is the case in breast and abdomen operations. Here surgery is not recommended because of the risks that are entailed and because the results could be unsatisfactory due to the patient’s state.

Whether we want it or not, Plastic and Cosmetic Surgery is a complete medical and surgical activity with its deontology, its medical and legal rules.

...........................................................................................Top of the page


How to go about it?

The decision to have Plastic Surgery can be taken in various manners. First, it can seem obvious after a personal examination. For example, every morning, day in day out, the mirror may reflect new wrinkles as the cheeks begin to sag, and you may see that the skin has lost most of its elasticity. The breasts may also be losing some of their firmness when compared to photos of earlier days. The decision can also be made because of conscious or unconscious psychological reasons that make that person want to change his or hers appearance.

One of the deciding factors can be the family, friends, working relations that may encourage a physical change. Some might even be influenced by the various magazine articles, or by a television programme. Sometimes a visit to the G.P. or a specialist can also help take this decision.

Once it has been taken, there is the first visit to the Plastic Surgeon. During this time there will be many questions asked on both sides, and the practitioner will try to fully understand what the patient’s motives are, but if he realises that the request is groundless he must convince the patient that he is wrong. The practitioner must give all of the information concerning the operation, the technique that will be used, the length of the operation, the kind of anaesthesia, the post-operative, and the risks and delays before the definite result. An estimate of the cost should also be given to the patient.

Lastly, if the operation is programmed, the practitioner, depending on the kind of intervention, will prescribe a list of medical examinations that need to be done prior to the operation.

...........................................................................................Haut de page


How to choose a Plastic Surgeon?

In the past few years Plastic and Cosmetic Surgery along with certain Plastic Surgeons have been on the front pages of women’s magazines. This shows that Plastic Surgery has now become part of everyday life. All the same, few people accept to talk about their operations, contrary to the U.S. where all exterior signs of social belonging are looked upon favourably, as in general those who turn to Plastic and Cosmetics Surgery are financially well off. This is why it is easier to talk about the “ruined” cases and the “horrors” of Plastic Surgery than it is of its successes which represent the vast majority of cases.

The various positive and negative appreciations that the general public, the medical world and even the journalists formulate about the Plastic Surgeons, make it seem as though they wish to give them a special statute, or at least a different one than that of standard surgeons. The fact is that when a patient wishes to consult a Plastic Surgeon for a possible operation the first question that he asks himself (and that he doesn’t always dare say) is: Is he qualified, competent, and experienced? So, yes, the question of “How to choose a Plastic Surgeon?” is very legitimate.

The Surgeon’s fame and notoriety can influence this choice. As in all other professions that have a privileged relationship with the general public, there are some “driving-forces” who have made their mark through their professional qualities, their ability to renew themselves, and their enterprise. They are often very charismatic and therefore the press and the television interview them gladly on the latest existing procedures. More so as the summer season approaches. In women’s magazines you can invariably find a whole series of articles, marketing research studies and even polls on the subject. It is easy to understand how they turn to these highly publicised surgeons for Plastic Surgery.

Word of mouth is also another excellent way of choosing your Plastic Surgeon. Many Surgeons have their clientele first come to them recommended by friends. That is another reason why the first visit is so important. But word of mouth can work in two ways as it can also discredit a surgeon who has been unable to satisfy a patient. But if it is a person who has been successfully operated on who is giving the advice, then you do benefit from his experience.

The G.P. can also recommend a Plastic Surgeon whose experience and surgical skills he appreciates. But it is unnecessary to see your G.P. just for getting his opinion on a Plastic Surgeon.

There is also advertising. Publicity that is found in various specialised magazines in Plastic and Cosmetic Surgery. As Doctors in general are not supposed to advertise, the independent clinics are allowed to do so and can therefore make their own publicity. But you must be aware that this is just publicity - under no circumstances does this guarantee the skills and experience of the surgeons there.

In France, the safest way to finding out the qualifications and skills of an individual surgeon remains the Regional and National Board of Medical Doctors, the “Ordre des Médecins”. This is the only entity that is authorised to legally value a Plastic Surgeon’s skills, stipulating if he is a qualified surgeon or not. Remember that in France all Medical Doctors are authorised to operate.

Also in France, in January 1997 a Government Act was passed in regard to the practice of Medicine and of Plastic Surgery. This Act stipulates that all practicing Doctors are to in all cases, give the patient what the text names as an “estimate” (un devis) This formal paper details the cost and procedure of the operation and also informs the patient on the Doctor’s credentials and whether or not he is a qualified Plastic Surgeon.

For those who would consider having an operation in another country, remember that each country possesses the same type of organisation as the France’s “Ordre des Medecins”, to which anyone can request information as well as to the different associations or organisms representing Plastic Surgeons. In the United States, for example, some institutions are very well-known for the exclusive speciality of Plastic Surgery. Fame and competition allows for the recruitment of highly skilled surgeons. Those institutions give information on Internet, where one can find out all that is needed to know.


...........................................................................................
Top of the page


Should one be ashamed of having Plastic Surgery?

In today’s world where the acquisition of new technologies and the speed in which science has accelerated makes us believe – often erroneously – that nothing is impossible and that everything carries human responsibility, the actual individual takes on an exceptional dimension where even religion has little space. To a great degree, today’s high sense of individuality comes after having achieved freedom of mind and soul, and consequently is now focused on the individual’s physical freedom. Everyone is free to dress and appear as they wish without consequence. The freedom of choice that each individual has of changing physique is now the ultimate phase in self-realisation. Very few people will nowadays be offended by nose piercings, tattoos or a nose job.

Why should we have to accept a physique that feels more like a handicap, when in today’s world it is not only allowed to model one’s shape, but also individuals are encouraged to be attractive, including physically? There is only one possible answer. All the other people who do not have to live with an ugly or deformed nose, with ears that stick out, an appearance that in the street attracts compassion or even laughter, and who are simply not affected by the passing of time, for these people only, the question has in fact no meaning.

As far as “shame” is concerned, should we then question if we are on Earth in order to rid ourselves of the Original Sin and consequently let our bodies become a burden? Does our body then belong to the Creator and therefore should we then ignore modern science and, for example, avoid correcting short-sightedness, a broken tooth which would beautify our physique? Should we then allow ourselves to be inconvenienced by modern life without taking advantage of it?

Is it not legitimate to want to appear more physically pleasing whilst being more pleasant to live with, since we know that improving the exterior also means to improve the interior?



Top of the page

 

 

 
 

© All rights reserved. Docteur Victor Cohen.