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Dr. Abrams was quoted in August SRQ Magazine:

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Body Dimensions: Ageless Beauty

Despite the current economic downturn, it seems we still want to stay young and beautiful. According to the American Society for Aesthetic Plastic Surgery (ASAPS), there were nearly 12 million cosmetic procedures performed in the U.S. during 2007, an eight percent increase from 2006. Non-surgical procedures accounted for 82 percent of that total, and altogether they cost us just under $13.2 billion.

This rising demand is even starting to have an impact on the medical profession itself, with the brightest and best medical students migrating from the field of disease management to cosmetic specialties—according to the Association of American Medical Colleges and the National Resident Matching Program, plastic surgery is now one of the most competitive residency programs. So what’s influencing the popularity of cosmetic surgery, what can it do for us and are we falling into the trap of thinking our looks matter more than who we are?

Age shall not wither us
Baby boomers and our aging population are two major driving forces behind the rise in cosmetic procedures—from 2002 to 2007, the age of patients seeking the top 10 most performed invasive procedures (including liposuction, sclerotherapy, facelift and forehead lift) has increased by two years. Hot on their heels is Botox, the most popular non-invasive procedure, which has experienced a two-year increase in average age.

Census reports indicate that baby boomers make up around 28 percent of the national population. They’re aging more healthfully which means they’ll likely stay in the workforce for longer. “They see a youthful appearance as key when it comes to impressing colleagues and prospective employers,” says Dr. J. David Holcomb, double board-certified facial plastic surgeon and immediate past president of the Florida Society of Facial Plastic Surgeons. The stats back up Holcomb’s theory: According to the American Academy of Cosmetic Surgery (AACS), around 65 percent of men and women report that they have plastic surgery in order to remain competitive in the workplace.

And while cosmetic surgery has traditionally been seen as a gal thing, it’s rapidly becoming a guy thing, too—a survey by the ASAPS reveals that men and women are now pretty much level-pegging in their approval of plastic surgery, at 61 and 63 percent respectively. The AACS reports a 13.7 percent increase in the number of men having cosmetic procedures since 2002 and that 20 percent of cosmetic surgery patients in 2007 were men. A recent UCLA survey suggests that 23 percent of men are interested in having plastic surgery in the future. It’s a national trend that both Holcomb and board-certified dermatologist Dr. Bradley J. Abrams are seeing reflected locally. “I’m definitely seeing more men who are interested in utilizing the dermal fillers that have been seen as the preserve of women,” Abrams confirms.

Needle or knife?
SRQ imageIt seems conventional procedures might be making something of a comeback, although they’re still trailing in the dust of “lunch hour” procedures such as Botox and injectable fillers. The ASAPS reports that facelifts are up by 14 percent for patients aged 40 and over, with over 116,000 performed in 2007; the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) also reports a rise. Board-certified plastic surgeon Dr. James Schmidt says this increase is apparent at Sarasota Plastic Surgery Center. “We’ve seen even more facial surgeries than the national trend would indicate,” he says. “The reason for this is most likely the fact that the median age in our community is over 50, which is when people begin to consider facial surgeries.”

But while some people may be leaning back towards more effective and reliable approaches to fighting aging (perhaps looking for longer-lasting results and more value for money as the economic downturn starts to bite), the resurgence of the facelift still can’t compete with the number of non-invasive cosmetic procedures—up by nine percent in 2007. And Holcomb says he’s seen no sign of facelift frenzy here in Sarasota. “I think what’s happening as far as the figures are concerned is that surgeons are doing various types of ‘minilifts’ and reporting these procedures as facelifts,” he suggests. “I do a significant amount of revision surgery ... and recently this has included revisions of ‘mini’ or ‘lifestyle’ lifts.”

Abrams agrees. “Injectables are still way ahead of the pack locally when it comes to cosmetic procedures,” he says. “Newer fillers, such as Juvederm and Radiesse, do offer the more durable effects people want—as long as 18 to 24 months with some products—and there are fewer side-effects with the newer options.” Abrams is a big fan of Sculptra, which boldly goes where no filler has gone before. “Aging involves loss of fat volume and bone mass in the face which older fillers couldn’t reverse,” he explains. “Sculptra re-volumizes and refills the face at a much deeper level that older fillers couldn’t achieve.” It’s an effect that can work hand-in-hand with surgery, he says, for the ultimate in facial rejuvenation. Holcomb, too, says that most patients obtain the best results from a combination of procedures. “Lifting procedures address sagging while volume loss can be repaired with injectables and signs of aging treated with light and laser therapy.”

Keeping up appearances
Is it a bad thing that we should invest so much in how we look? Not at all, says Holcomb. “Body image impacts on a range of things from career success to social skills—and facial rejuvenation has been shown to improve self-esteem.” Schmidt is in full agreement: “The number one reason we hear for having cosmetic surgery is that people want to feel good about themselves.”

SRQ imageSo why shouldn’t we take steps to improve something that has been bothering us at a profound level? Take breast enlargement, a procedure Schmidt says is popular among his 18- to 30-year-old patients. It’s often written off as the most extreme example of invasive plastic surgery carried out for trivial reasons. But research from the University of Florida suggests that women who undergo breast enlargement often experience a sizable boost in self-esteem and positive feelings about their sexuality. And a 2006 study by the American Society of Plastic Surgeons (ASPS) even suggests that plastic surgery may act as a natural mood enhancer—researchers found that a significant number of patients stopped taking antidepressant medication after undergoing cosmetic surgery, and 98 percent of the participants said it had markedly improved their self-esteem. So it seems that far from being trite, cosmetic surgery may well have important physical and psychological benefits.

That said, cosmetic surgery shouldn’t be seen as the solution to low self-worth, and we shouldn’t expect life to change for the better simply because of surgical improvements. “You’re more likely to be happy with the results of cosmetic surgery if you have realistic expectations about what you hope to achieve,” says Holcomb. Schmidt feels the same way: “Some patients do have unrealistic expectations, which is why we provide a consultation with the plastic surgeon to discuss expectations versus what is possible.” By all means, use the celebrity du jour as a starting point to help you decide what you want—but keep in mind that cosmetic surgery is designed to enhance your own features, not duplicate Angelina Jolie’s. Have your doctor explain the full range of possible results, and don’t be misled by computer imaging—while it can give you an idea of how you’ll look, there’s no guarantee that the end results will match those created by the computer. With some types of surgery, the results may not appear for several weeks or months after the procedure. With others it may take several sessions or a combination of procedures to achieve the look you want, and results are not always permanent.

Remember, too, that the effects of time, sun exposure (particularly here on the suncoast) and overeating will persist after cosmetic surgery. “A facelift or filler doesn’t free you up from a careful skincare regime,” Abrams points out. “Cosmetic surgery, whether invasive or injectable, is no substitute for good health habits.”

Try to have realistic expectations about how cosmetic surgery might affect your life. Changing an aspect of your body that you are not happy with may make you feel more attractive, more satisfied with your appearance and freer to do things that in the past made you uncomfortable, either emotionally or physically. For some people, the impact may be dramatic. But the message from both Holcomb and Abrams is that you shouldn’t expect cosmetic surgery to solve all your problems. It may change how you look and feel, but it won't change who you are.

Can’t do, won’t do?
What’s your alternative if you can’t afford cosmetic procedures or don’t want them? Here’s where Abrams’ good health habits come into the equation. Proper nutrition and regular exercise are key when it comes to preserving a youthful appearance, he says. “You should also make a point of wearing sunscreen since sun exposure is one of the main culprits when it comes to aging,” he continues. “And quit smoking—as well as causing wrinkles around the mouth from pursing your lips to grip your cigarette, it decreases oxygen in the tissues, robbing skin of its healthy glow.”

Something you might not have considered for arming yourself against aging is the acupuncture needle. Board-certified Doctor of Oriental Medicine Anna Baker, of Faces by Dr. Anna, says that her acupuncture facelift can help you regain a more youthful appearance at a fraction of the cost of invasive surgery. “In traditional Chinese medicine (TCM), stagnation of energy in the face and body leads to loss of muscle tone as the person ages,” she explains. “Unblocking the stagnation, over a series of treatments, causes the muscles to regain their tone.” Baker uses 12 thin needles to achieve this. “They cause the muscles to tighten and start to return to the facial proportions the person had when they were younger,” she says. “The eyes open wider, the brow lifts, the cheeks get fuller, the jawline tightens. In addition, lines and wrinkles flatten and lift to return the face to a more sculpted look and it only requires one maintenance treatment every 18 months to keep the tightness after the initial series of treatments.”

Baker points to improved health as an added bonus of her acupuncture facelift. “Since TCM is ‘whole body’ treatment, I have had many patients report improvement in their health and a wide variety of physical conditions.”

Find Out More
Holcomb Facial Plastic Surgery, 1 S. School Ave., Ste. 800, Sarasota, 941-365-8679; Abrams Dermatology, 3328 Bee Ridge Rd., Sarasota, 941-926-2300; Sarasota Plastic Surgery Center, 2255 S. Tamiami Trl., Sarasota, 941-256-3938; Faces by Dr. Anna, 3131 Clark Rd., Sarasota, 941-924-2723

Generation Awareness

Twenty-somethings are more likely to approve of cosmetic surgery than those in any other age group. Breast augmentation is the most popular invasive procedure across this age range and among 20–30-year-olds—Botox, microdermabrasion and laser hair removal are the most popular non-invasive options. Once you hit your 30s, you’ll have more obvious signs of aging in the form of crows’ feet, but not too much loss of volume—for 900,000 Americans ages 30-40, Botox is the answer.

Your cheeks are losing fat and laugh lines are setting in, but you’re finding the solution in Botox—over 3.5 million Americans are using it. By your mid-50s, your skin has relaxed and it may take a combination of filler implants and a facelift to rejuvenate your face. As far as invasive procedures go, your cosmetic surgery habit is also reflecting the likely increase in your girth—for those in their 40s, liposuction is the most popular option.

Seniors aged 65 and above are 11 percent more likely to approve of cosmetic surgery now than they were in 2006. You’ll be battling hollowness from losing a large quantity of facial fat and having a sizeable amount of hanging skin. Facelifts during these decades often replace some of the volume while also removing excess skin to present a smoother, fuller face.

SRQ Magazine—By Kate Brophy

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Abrams Dermatology

(941) 926-2300 • Toll Free (866) 271-8796 • 3328 Bee Ridge Road • Sarasota, FL 34239