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Pleasing Proportions

Karen, a 31-year-old woman from a middle-class family, has always been self-conscious about her profile. On a recent visit to the Duke Center for Aesthetic Services, she sat down with Michael Zenn, MD, as he “morphed” a side view of Karen’s face with computer technology to show what she would look like after surgery.

Delighted by what she saw, she decided to move ahead with plans to have a rhinoplasty (nose recontouring) and chin implant this summer. “Here’s a young woman who’s been saving up for this procedure for years,” says Zenn. “And she’s really looking forward to it.”

In many ways, Karen represents the evolution in popular attitudes toward plastic surgery over the past few decades. It’s a change that can also be neatly summed up by the titles of two popular television shows from opposite ends of that timeframe: “Lifestyles of the Rich and Famous” and “Extreme Makeover.”

Cosmetic surgeries and skin rejuvenation treatments were once considered the exclusive domain of Hollywood stars and the wealthy. But now, thanks to shows such as “Extreme Makeover,” such procedures are increasingly sought out by people from all walks of life, including those of modest means and/or over 60 years in age.

The number of cosmetic procedures performed in the U.S. has increased by 446 percent in the past ten years alone. About 1.9 million Americans had some type of cosmetic surgery in 2006; about 9.5 million more opted for a non-surgical procedure such as Botox injections or chemical peels -- for a total cost of some $12.2 billion.

Unfortunately, the money wasn’t always spent wisely. Cosmetic procedures, performed by experts after extensive, candid consultation, can dramatically improve patients’ lives. But cosmetic surgery’s boom in popularity has also been a boon for practitioners who may lack skill, scruples, or both -- with less than ideal results.

“It’s a sad fact, but some people spend more time choosing a refrigerator than they do a plastic surgeon,” says Zenn.

Even when surgeries are completed without complications, patients can be disappointed if results don’t match expectations. “Patients come in with a vision of what they want,” says Gregory Georgiade, MD.

“The surgeon needs to translate that into what’s feasible, and make sure the patient’s expectations are realistic and that they’ll be comfortable with the likely results. That’s why we put in a lot of time with patients up front. As a result, there are occasions when the patient will change his/her mind about the procedures they originally came to discuss.”

Sometimes, the most responsible thing a plastic surgeon can do for a prospective patient is to explain gently why what they want to have done won’t give them the results they seek. That’s especially true, Georgiade says, when it’s clear that a person isn’t trying to repair a physical feature so much as a troubled relationship or a tenuous self-image -- something no procedure, no matter how well done, can guarantee.

It’s a delicate line to walk. On one recent day, Zenn says he saw 15 new patients -- and turned away three of them. “I tell them, ‘I don’t think you’re a candidate for this procedure. I only get paid if I actually do these procedures, yet I’m telling you that you shouldn’t have it done.’ I add that if they keep looking, they’ll find someone who will do it, but they won’t be happy with the result.”

One of those patients was a woman of about 70 pounds overweight requesting liposuction, Zenn says: “I had to tell her that liposuction is not a substitute for weight loss -- it’s a contouring procedure for people whose weight is stable.” (The woman decided to lose some weight, then come see Zenn again.)

For people who have achieved dramatic weight loss -- often as a result of bariatric surgery -- body contouring is often the crucial final step to a positive self-image. “Body contouring is a new field with increasing numbers due to high demand,” says Detlev Erdmann, MD, who specializes in body contouring.

While insurance carriers usually cover weight loss surgery, most don't cover contouring. “After bariatric surgery, patients often experience massive skin redundancy, and they are left alone. We try to provide these patients acceptable quotes to have these procedures performed.”

Surgeons disagree whether shows like “Extreme Makeover” have been good for their specialty. They say viewers sometimes get the impression that the whole process can go a lot more quickly than ethical practice (and real-world physics) allow.

In general, however, Drs. Georgiade and Zenn believe that -- thanks to resources such as television programs that actually show plastic surgeries and the wealth of information available on the Internet -- patients are much more informed than they used to be, and are usually quite realistic about what they’re hoping to achieve.

“Most people don’t really want extreme makeovers,” says Zenn. “They want to look younger to match the youthful way they feel, for example. And even though subtle things like a reshaped nose or slimmer thighs may seem like no big deal to you and me, they’re often all our patients need to feel better about themselves and to have the confidence to make big changes in their lives.”

What’s important to remember, the physicians caution, is that even seemingly minor procedures demand significant expertise. “Here at Duke, we’re all highly trained to who are qualified in every cosmetic procedure,” says Georgiade. “We work in a fully equipped, state-of-the-art surgical facility that has been accredited by JCAHO (Joint Commission on Accreditation of Hospitals -- the same entity that scrutinizes and certifies hospitals).”

And because the facility is housed in a freestanding building on the leafy Center for Living campus, patients don’t have to choose between the comforting expertise of Duke specialists and the comfortable, private setting that plastic surgery patients understandably seek.

An important issue that should be (but isn’t always) considered when choosing a plastic surgeon is how anesthesia will be administered. “Many people who call themselves plastic surgeons do all their procedures in an office without an anesthesiologist, using only an oral sedative and a few numbing shots,” says Erdmann.

“To put it mildly, that can make for a very bad experience on the part of the patient. Here at Duke, we have a dedicated cosmetic anesthesiologist (Dianne Scott, MD) whose exclusive focus is on keeping the patient comfortable and safe, allowing the surgeon to concentrate on the procedure.”

“People often come to Duke after bad experiences elsewhere,” says Erdmann. “They went to people who weren’t really qualified to do those procedures in the first place, and who -- when they got into trouble -- had no depth of experience to get out. We have the expertise to help these patients, but we can’t help wishing they had just come to us first.

“Even worse than the negative outcome for a lot of patients is a sense of abandonment, a feeling that the aftermath wasn’t dealt with appropriately,” Erdmann adds. “Their concerns have been dismissed with a ‘you look fine’ kind of attitude. Any practitioner can encounter a complication, but you have to own that. It’s important to be honest with your patients and to take responsibility for your work. That’s the way we do things here at Duke.”

It’s an approach that gets high marks from scores of patients. “We have files bulging with thank-you letters from patients,” says Zenn. “The beauty and challenge of this specialty is that there’s no hiding your work. It’s right out there in the open for everyone to see.

“The fact that our patients are so happy is our best possible advertising.”

Duke Center for Aesthetic Services -- Procedures Offered
Minimizing the Effects of Aging

Facelift
Eyelid surgery
Laser skin resurfacing
Brow and forehead lift
Skin rejuvenation (collagen injections, chemical peels,Botox injections)
Varicose and spider vein treatments
Redefining Facial Features

Surgery of the nose
Lip, cheek and chin Augmentation
Ear surgery
Body Contouring

Liposuction/Body contouring
Breast augmentation, reduction and lift
Abdominoplasty
Refractive Eye Surgery

LASIK (Laser Assisted In Situ Keratomileusis)
LASEK (Laser Epithelial Keratomileusis)
PRK (Photorefractive Keratectomy)
Other Laser Procedures

Tattoo removal
Rosacea treatment
Port-wine stain treatment
To familiarize you with our procedures, the Duke Center for Aesthetic Services offers a full array of seminars, personal consultations and literature. Get more information about Duke Aesthetic Services.

Who’re You Gonna Call?
Thinking about a cosmetic procedure? Keep the following points in mind when choosing a practitioner.

Be wary of doctors billing themselves as “facial plastic surgeon, board certified,” which sounds -- but isn’t -- the same as “board-certified plastic surgeon.” They may actually only be board-certified in another specialty such as dermatology, oral surgery, or ENT (ear/nose/throat). Settle for nothing less than accreditation by the American Board of Plastic Surgery.
Doctors who are trained only as facial plastic surgeons sometimes begin offering tummy tucks, breast augmentations, and other body recontouring procedures that are out of their area of specialty, after having no more than a weekend’s worth of training. Make sure your surgeon has received adequate training in the procedure you’re considering.
There are lots of “pop-up, overnight boards” out there. Your surgeon should be “boarded” by a board recognized by the American Board of Surgical Specialties.
To find a board-certified plastic surgeon, visit the American Society of Plastic Surgeons at www.plasticsurgery.org. Most plastic surgeons who are board-certified or board-eligible are members and will be listed.
Double-check a doctor you’re considering for a procedure by visiting your state surgical board’s Web site to see if there are any complaints against him or her.
Consider a second opinion at a facility such as Duke -- where there is far less financial incentive than in private practices, and where you can receive more objective confirmation that you are a good candidate for the procedure you desire.


Weight Of Money On Betting Exchanges

There are several methods to train our body to relax like yoga, exercise, dancing, gyming, etc. but there’s only one way to relax our minds, i.e. through meditation. Meditation helps inculcate a lot of strong emotions and health benefits by channelising the internal positive energy that often gets subsided in our busy life. Students perform meditation to concentrate on their studies, be patient and learn to respect others while the elders choose meditation to relax their nerves from the daily chores, conflicts and deadlines. It genuinely helps them to get back on track and focus at the job in hand.

There are several techniques for meditation. The widely practiced and accepted technique is the “Concentration Meditation”. This usually involves the subject to concentrate on a particular thing like your breathing, a lighted candle or a particular object like the Maha Bodhi Tree was for Lord Buddha while sitting or standing at a position for a stipulated amount of time while blocking out your surroundings completely. This is advised to people with hypertension or type A personality where your brain just keeps worrying and thinking a lot. This induced tension can be put to ease when you look or concentrate on your object of meditation. In contrary to the former type is the “Mindfulness Meditation”. In this, the subject not just focuses on a particular item but tries to go through all the thoughts and emotions that flow into the mind at that particular moment. This form usually helps us to analyze, organised our thoughts that come into our head and helps us introspect. This type of medication is very helpful when we are going through an emotional crisis. It not just helps us to understand the present scenario but also helps us find the window of hope amidst the darkness.

In the world of meditation three things are very crucial that determines your personal technique of meditation- the position, the place and the time period. Generally, the Padmasana or “Lotus-position” is considered as the ideal position as it helps in better flow of blood through the body but this is not the mandatory position as many people find it hard to expertise this position. The whole point is to make our body relax through our mind. So, a variable positions are available like the “Hero position”, sitting cross-legged, sitting with your legs wide apart, standing, lying down straight or simply sitting on a chair. Some people prefer to sit on a normal meditation mat while others prefer a special meditation chair. Next, comes the place. You need a very quite and relaxing surrounding in the beginning in order to help concentrate. There are special meditation music, some prefer scented candles to fragrant flowers or lighted incense sticks that can instantly help them relax. Some people prefer doing it in special rooms or temples whereas some find Mother Nature more nurturing. Lastly, how long and most importantly when do we meditate? Generally, it takes time for the beginners to find their appropriate time of the day and period of meditation. They must start with a few minutes at sunrise or sunset and later prolong the time period according to their convenience. Therefore, depending on these three factors we need to personalize our “individual” technique of meditation in order to make us a more grounded, relaxed and positive person.

Ressource: https://healthlinerx.org/