COSMETIC SURGERY

THE TERM COSMETIC SURGERY conjures up images of film stars, beautiful women, California, a surgical extravaganza undertaken to satisfy the fantasies of a woman or her surgeon.

New Zealanders are more down-to-earth, practical people. When it comes to cosmetic surgery these characteristics are seen in both the surgeons who practise cosmetic surgery, and people who request it.

Although at one time, especially in Europe and North America, cosmetic surgery was mainly sought by wealthy society women, these days people of all kinds (mainly women) consult plastic surgeons to have some procedure to make them feel better about themselves - not always to make them look more beautiful.

This book was written to provide accurate, inexpensive and readily available information about cosmetic plastic surgery for the general public, in the hope that it will help demystify cosmetic plastic surgery and its practitioners, and guide consumers to seek the best possible advice and treatment.

Each of the more common procedures performed in New Zealand is explained. Details of pre-operative preparation and post-operative care are provided, along with the advantages and disadvantages, and risks of individual procedures.

We have tried to provide an easy-to-read but factual account so that prospective patients can decide whether their expectations are realistic, and participate more fully in the decision-making.

The information in this book is based on the experience and knowledge gained by New Zealand cosmetic plastic surgeons over the past 30 years, both in New Zealand and overseas. It also relies on being informed about recent developments both here and overseas.

THE HISTORY OF COSMETIC PLASTIC SURGERY

Cosmetic plastic surgery is not a recent trend. Throughout recorded history, women (and in some cultures, men) have gone to extraordinary lengths to ensure they conform to what were considered society's norms. In tribal cultures, devices such as mouth-plates, neck-rings, and nose and ear stretching or piercing were common. Men, in some societies, underwent primitive surgery by tattooing or mutilating the skin to produce large obvious scars, or other tribal marks, which increased their mana and tribal standing.

Before the development of aseptic surgical techniques in the last century, many of the attempts to conform to norms in Western society were limited to devices which changed or masked faces or figures. For example, women applied white lead paste to their faces to produce the highly sought-after pale complexion of the 14th century. More recently, corsets were worn to slim waistlines. As germ-free surgical techniques developed in the 19th century, and anaesthetic techniques were improved and became safer in the early part of the 20th century, the door was opened to a whole range of body improvement techniques using plastic surgery. As often happens, surgical ideas were very much in advance of the technology available to produce them.

German surgeons coined the terms "plastic surgery" and "cosmetic surgery". The term "plastic surgery" is derived from the Greek plastikos, which means to mould or shape, and cosmetic is derived from the Greek kosmesis, meaning beauty. Aesthetic is also a word meaning beauty and is sometimes applied to surgery of this type.

Plastic surgeons mould or shape tissues into a more aesthetic and acceptable shape by surgical techniques developed over the past 50 to 60 years. Some of these techniques evolved from reconstructive procedures used during the First World War to repair the effects of injury, especially to the faces, noses and eyelids of soldiers.

COSMETIC SURGERY TODAY

Most people seek cosmetic surgery because they want to feel more comfortable with their appearance. They rarely want surgery done to satisfy others. They are concerned about perceived or actual inadequacies in their appearance which they want to improve.

Many people feel embarrassed or concerned that others may think they are vain, and are often secretive, defensive and reluctant to talk about their concerns, or even to discuss the possibility of cosmetic surgical treatment with their friends or family. For this reason, the subject tends to be clouded with mystery, and women - who make up 90 per cent of the clientele of most cosmetic surgical practices in this country - tend to get most of their information from popular magazine articles and television documentaries.

These articles and documentaries can be very helpful and informative but they are often incorrect or may over-simplify the matter so that major surgical procedures are trivialised. On the other hand, they may sensationalise some of the unfortunate complications which, in most cosmetic surgical practices, are extremely rare. In this way they may deter people from seeking professional help to correct something which would normally produce a very satisfactory outcome.

We do not claim that cosmetic surgery is the whole answer to people's problems or that their lives will be miraculously changed by a cosmetic procedure. As Sir Harold Gillies, a New Zealander and one of the world's most famous plastic surgeons, said: "We cannot always change these people's lives, but we can at least give them a good hand of cards and a better chance of winning..."

It is the experience of all cosmetic plastic surgeons in New Zealand that cosmetic surgery, used properly and responsibly, is very enriching for many people. We live in a highly competitive society that places considerable emphasis on youth and accepted standards of beauty. Cosmetic plastic surgery helps to provide some of the emotional and physical support needed to allow people to live their lives as fully and completely as they wish.

Responsible plastic surgeons do not operate on demand, nor will they contemplate trying to produce changes outside what society considers its norms. We do not see cosmetic surgery as trivial, as someone just having their nose "tweaked" or doing a "tummy tuck". It is surgery and involves risks, including those of anaesthesia and infection, wound breakdown and haematoma (collections of blood in the wound). There are also specific complications associated with each procedure.

ADVERTISING

In the past the code of ethics for the medical profession have not allowed any member to advertise his or her services. Referrals to individual practices were by word of mouth, or from general practitioners, and surgeons have, in these instances, responded to public demand rather than creating demand for individual services.

Currently, our view is that advertising is acceptable as long as it is a statement of the qualifications of the practitioner, and of the services provided by individual practices in any particular field of activity. We decry advertising which aims to recruit people for individual surgical procedures to which they may not be well suited or, indeed, to create a public demand for a procedure for which there was little prior demand. We regard liposuction (liposculpture) in the 1980s and early 1990s as belonging in this category. Many of those people who had this surgery would have been managed better with diet and exercise regimes.

We take the view that surgery is still the last resort in managing cosmetic problems and is a powerful tool that should be used with care and responsibility.

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