Medical & Trade Publications

May 2006

by Amy M. Ortega, M.D.
Medical / Plastic Surgery

The Question is 'When'

With the recent surge in the popularity of plastic surgery and beauty-related procedures, the question I am often asked is, "When should I start having plastic surgery?"

I think it comes down to two major issues—age and life situation. Certain age ranges naturally dictate the need for age-related procedures, while certain life events will create a need for certain procedures at any age. With the vast range of procedures now available, which offer everything from subtle improvements to major changes, it seems there is always something for everyone.

Some surgeons suggest age-related maintenance surgeries. These allow for gradual improvements.

A matter of time

All ages should get in the sunscreen habit—it's the best way to protect skin from premature aging that results from sun exposure. I recommend an SPF 15 or above with a physical sunblock such as zinc oxide.

Teenage, as well as adult men and women: Skin maintenance should include cleansing to prevent acne, treatment of acne, and sunscreen applications, of course.

Female teens: Breast reduction, or correction of congenital breast development issues, such as gross asymmetry.

Twenties: Breast augmentation, liposuction. All should continue skin protection with sunscreen and begin skin maintenance with microdermabrasion and professional skin care products to protect and hydrate.

Thirties: Body contouring, especially after pregnancy. This may include breast augmentation, mastopexy (breast lift), abdominoplasty (tummy tuck) and/or liposuction. It's also time to consider slightly more aggressive skin maintenance procedures such as light peels or exfoliating products to help prevent fine lines.

Forties: Time to begin age-related "maintenance" surgeries; mini-facelift, conservative brow lift, or eyelid lift, if needed. Slightly more aggressive skin peels or IPL (intense pulsed light), depending on status of skin's aging and previous sun exposure.

Fifties and beyond: Aggressive, age-related facial rejuvenation surgery, which includes facelift, eyelid lift, neck lift and brow lift. In addition, total body contouring is often needed to combat the effects of pregnancy, aging and weight changes. In addition, aggressive skin resurfacing is recommended—deep peels or laser resurfacing for improvement of wrinkles, and increased collagen production to tighten skin.

In various cases, some procedures are typically discussed in tandem, such as facial rejuvenation surgery and laser skin resurfacing.

Countering gravity's effects

Pregnancy and weight changes produce major changes in one's figure, and create a need for body contouring procedures, regardless of age. With age, the abdomen muscles weaken, and the abdomen may appear more prominent than before, especially in the lower abdomen. Pregnancy and weight change also add to the stress on the abdominal muscles.

Although men and women both endure aging and weight changes, women have the added bonus of physical changes from pregnancy. Many women don't realize that during pregnancy, the supporting muscles of the abdomen, called rectus muscles, are stretched and even separated. After the baby is born, the size of the abdomen decreases, but the separation of the rectus muscles remains: rectus diastasis is the reason why so many women are frustrated with exercise when they try to reclaim their pre-pregnancy figures.

No matter how many stomach crunches a woman does, those rectus muscles will remain separated, and the lower abdomen will remain weak, manifesting as the very unpopular "pooch." In addition to that, the stretched abdominal skin almost never returns to its previous appearance, often hanging empty.

Of course, another aspect is the weight gain during pregnancy that is so difficult to completely overcome, especially in the abdomen. The end result is poor abdominal contour, which, of course, affects one's overall figure, how clothing fits, etc.

Dramatic weight gain or weight loss can both affect the abdomen as well, producing changes similar to post-pregnancy—rectus diastasis, excess skin and excess fat.

Tummy tucks and other fixes

The procedure best suited to address all of the previously mentioned issues is an abdominoplasty. This procedure combines the removal of lower abdominal skin and fatty tissue with the added advantage of an internal tightening of the rectus muscles for better support. Through a lower abdominal incision, the surgeon can raise all tissues on the abdomen, all the way up to the rib cage. The surgeon can then visualize and repair the rectus muscles. The skin and soft tissue are then re-draped and the excess tissue is removed.

Another post-pregnancy issue is breast volume and shape. During pregnancy and lactation, the breasts become engorged. Afterward, the breasts involute, often leaving less volume than the woman had before. This can leave the appearance of an empty, hanging bag of skin, which can be addressed with a breast lift, with or without an implant, depending on the woman's size preference. I, of course, recommend the SPAIR short-scar breast lift, which can be accomplished with or without an implant.

In addition to the obvious physical changes from pregnancy, there are also the issues of weight gain during pregnancy and the difficulty of losing all the weight afterward. Many women find that they have acquired new areas of accumulated fat, which are very resistant to weight-loss efforts. Liposuction is the ideal method to restore these contours.

One thing is certain—people are no longer waiting until they are in dire need; there is more of a trend toward "maintenance." Having one's procedures in the span of several years can help maintain appearance, and it avoids a dramatic change in appearance.

Subtle improvements are often not recognized as plastic surgery but rather as "looking more rested or refreshed," "looking like you've lost weight," etc. On the other hand, when there is room for dramatic improvement, there is usually a procedure or combination of procedures that can produce a significant change.

Amy M. Ortega, M.D., is a board-certified, double-fellowship trained cosmetic plastic surgeon with special interest in cosmetic surgery of the face, breast and body. Her office is located in Atlanta, GA. To reach her, call (404) 751-2500. For more information ABOUT DR. ORTEGA, visit her website, www.ASAbeautiful.com.