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Cinderella ending?

“My face is kind of a work in progress,” she said.

She’s 48. She’s had a face-lift, chin-lift, nose job, brow-lift, laser resurfacing and dermabrasion. Permanently tinted lashes and permanent liner define her eyes.

Her “to-do” list includes eye surgery, a mini face-lift and another chin-lift. “I will never tolerate turkey skin hanging from my neck. That makes a person look older than anything. I had my chin lifted in 1999, and the skin is starting to droop.”

Oh, yes. She’s also had her breasts lifted and enlarged.

“It is addictive,” she said. “People are just obsessed with it anymore. Once you have something done and all goes well, you think maybe you should try this and look even better.”

He’s 43. He’s had a nose job, laser skin treatment, upper-eyelid lift, silicone cheek implants, two brow lifts, Botox, three liposuctions and a cleft carved into his chin.

“I don’t know anyone who wants to accept this aging thing,” he said.

“I’m fighting aging, tooth and nail,” said a 64-year-old woman with a year-old face-lift.

Age rage?

“It’s cultural,” said Dr. Andy Stewart, a Charleston plastic surgeon. “Our Western culture places way too much emphasis on youth.”

From wrinkle creams and chemical peels to Botox and body sculpting, Americans are waging a multibillion-dollar war against growing old. In record numbers, they are paying through their capped teeth and reshaped noses to have offending, aging flesh lifted, shifted, sucked and sliced away.

Baby boomers, most of them. In 2003, people between 35 and 50 underwent more plastic surgery than any other age group, accounting for 45 percent of all cosmetic procedures.

So what’s with this aging thing?

“We lost a decade,” explained John Linton, chief psychologist with the West Virginia University Department of Behavioral Medicine in Charleston. “When we were youngsters, if you were 60, you were old. Now 60-year-olds are functioning like 50-year-olds, and 40-year-olds like they were 30. With nutrition and fitness and Viagra, people are feeling and acting younger.”

And they want to look that way.

“The definition of old is more negotiable,” Linton said, “and everyone is trying to be competitive in that new environment. Used to be, it was unheard of for men to dye their hair unless they were in the theater. Now The Wall Street Journal will tell you that dyed hair is one of the fastest trends in corporate America. Men with gray hair are considered over the hill.”

“The better you look, the more accepted you are in society,” said Dr. Augusto Portillo, a veteran Charleston plastic surgeon. “That’s the whole thing in this country. If you were born ugly, you’ve got a problem.”

But probably nothing that money and a good plastic surgeon can’t fix.

“People exercise to get their bodies in better shape, use skin creams, whiten and floss their teeth, sleep more and take vitamins, all noninvasive steps that don’t require a surgeon’s scalpel,” said Linton. “When they can’t fix it themselves, they turn to plastic surgery.”

Managing how we age

Last year, plastic surgeon partners Hans Lee, Ted Jackson and Daniel Wood handled more than 1,000 cosmetic surgery cases.

Stewart’s solo practice has a waiting list. “I’m almost overwhelmed,” he said. “I’m booked into June. I used to do all kinds of things. Hand surgery. Trauma cases. But I’m so busy with cosmetic surgery that I withdrew from all that. I don’t have time to do it all. I’m working on weekends to accommodate people.

“I don’t know what it is,” he said, “but it’s pretty much a nationwide phenomenon.”

According to the American Society of Plastic Surgeons, more than 8 million people chose cosmetic procedures in America last year, an increase of 293 percent since 1997 and a 32 percent increase over 2002. In 2002, Americans shelled out $5.4 billion for cosmetic surgery and $7.7 billion on surgical and nonsurgical beautification.

Lee said male patients make up 10 percent to 20 percent of his practice. Nationally, men accounted for 13 percent of all plastic surgery performed in 2001.

Dr. Rod Rohrich, president of the ASPS, explains the phenomenon this way: “We don’t want to grow old gracefully. We want to manage how we age.”

Along with the barrage of baby boomers, surgeons report more patients on the far end of the age scale. “People live now until they’re 90, and they’re still in good shape and want to keep themselves up,” Portillo said.

Nationally, the number of plastic surgery patients 65 and older jumped from 121,000 in 1997 to more than 425,000 in 2001, according to the American Society for Aesthetic Plastic Surgery. Their favorite procedure? Liposuction.

Face-lifts ranked fifth. A Charleston face-lift patient said she knows of a woman in her 90s who is contemplating a face-lift. Stewart recently put breast implants in a 69-year-old woman, “and that tickled us to death,” he said.

Older patients might be women experiencing a major life change, widowhood perhaps, or a return to the workplace, Portillo said. “Instead of sitting home watching soap operas, they want to get in society and mingle, maybe get married again or go back to work. Companies want a good-looking lady. A face-lift. A wrinkle smoothed out. Eyelid work. A tummy tuck. You can’t blame them for that.”

Lee says he sees more patients in their 40s wanting face-lifts. “We used to consider that too early for cosmetic surgery. Now they want a neck lift or a lower face-lift to stay ahead of aging.”

Several surgeons mentioned cosmetic surgery as a natural extension of beautification urges that blossom with the first blush of adulthood. “Look at piercing and tattooing,” said Jackson. “We’re a lot more liberal about what we do for beauty.”

“The trend now is for young people to have tattoos and rings around their belly button,” said Portillo. “They try to enhance themselves. Young people want to be attractive and seductive. Whoever can deliver those things, that’s wonderful.

“You don’t live twice,” he said. “You should enjoy every minute.”

Patient demographics show a wide socioeconomic range, not just the wealthy.

Cosmetic surgery attracts people from all walks of life now, said Rohrich. “It’s for everyone who wants to make a change in their life.”

“One of the more recent tummy tucks I did was for a woman who cleans houses,” Jackson said. “Her stomach had always bothered her. When we took the bandage off, she cried, she was so happy. It was very touching.”

Paying the price

Even the cheapest surgical procedures cost several thousand dollars, and few insurance policies cover elective cosmetic surgery. Reconstructive surgery, considered necessary and therefore covered by insurance, involves repairing deformities from injury, disease or birth defects. Elective cosmetic surgery involves reshaping normal structures to improve appearance and self-image.

Procedures sometimes fall into a gray area between the two definitions. Insurance might cover eye surgery, for example, if the drooping lids severely obscure vision.

“If it’s important to them to get a nose job because they’ve hated their nose their whole life, they can save for it,” says Rohrich.

Cosmetic surgery evolved from reconstructive techniques, Portillo explained. “We learned from those. If I have to fix a tumor in the nose, I have to cut and construct. The more of those you do, the better cosmetic work you do.”

And no, there is no plastic in plastic surgery, he said. “A lot of people think we’re putting plastic in their face or somewhere else.” The word actually evolves from the Greek word plastikos, meaning to mold or form.

Several patients interviewed for this series said they encountered criticism from friends for spending such large sums on beautification. A woman who had a face-lift last year defended her choice, saying it cost her no more than the accumulated cost of creams and potions purchased by friends over the years.

And from the 48-year-old woman with the “to-do” list: “This is my indulgence. There are no extravagances in my life. I don’t have jewelry or buy clothes. I have friends who wear jewelry that costs more than all the plastic surgery I’ve had. And it’s a better investment than a diamond, in my opinion.”

With media exposure helping to lift the secrecy that traditionally shrouded plastic surgery, many patients now view their makeovers as a kind of status symbol, surgeons said.

“It’s a sign of affluence,” said Lee, “almost as if they’d bought a fancy car. It’s like, yes, I can afford to have plastic surgery.”

A survey of 1,000 adults conducted nationally last year by the American Society for Aesthetic Plastic Surgery showed that 54 percent approved of cosmetic surgery. About three-quarters said if they had plastic surgery, they wouldn’t be embarrassed if others knew.

The stuff of fairy tales

Many observers credit Extreme Makeover, the popular reality TV show, for pulling plastic surgery out of the closet.

“It’s become a couch sport to watch other people,” said Linton. “Everybody loves a transformation. It’s almost reminiscent of fairy tales and fables. Cinderella went from being a homely servant to someone the prince wants to sweep away. The ugly duckling turned into a beautiful swan. These are eternal human themes.”

But surgeons caution that makeover shows can be misleading, leaving prospective patients with unrealistic expectations. The show furnishes subjects with extra services to guarantee optimum results, said Dr. Robert Bernard, ASAPS president. Those patients might have more than $100,000 spent on them, he said.

Rohrich warns that such shows also tend to sugarcoat the unpleasantness inherent in surgical procedures. “It is real surgery to be done by real surgeons in a real operation room. With that, is the potential for inherent real risks.”

Deaths from cosmetic surgery do happen. Olivia Goldsmith, 54-year-old author of “The First Wives Club,” suffered a heart attack and died recently while under anesthesia to remove loose skin from under her chin.

More likely risks include infection, bleeding, scarring, difficult recoveries and disappointing results, chances millions of Americans apparently are willing to take.

Patricia Ireland, former president of the National Organization for Women, finds that worrisome. In a CNN online article about older Americans having plastic surgery, she said: “The notion that age is unattractive has such a hold on all of us that we’re willing to cut up our faces, to have the risks of general anesthesia for somebody else’s idea of what’s beautiful is a little frightening.”

Movie and television stars, runway models and beautiful people in TV commercials and other advertising roles all foster America’s push for perfection, Linton said. “Beauty sells Toyotas. The drive for cosmetic surgery is at least in part fueled by media focus on aspirational beauty that is relatively unattainable for most people.

“People have been talking about this since the first Barbie dolls came out, the idea that girls should aspire to that figure and image,” Linton said. “Most dolls and TV stars don’t look representative of adult women.”

Qualified surgeons counsel potential patients about their expectations, starting with a likely first question: What do you expect the surgery to do for you? While better appearance and increased self-esteem might cause people to react to someone more favorably, said the ASPS, patients shouldn’t undergo surgery hoping to change anyone but themselves.

“We have to make sure people understand the limitations,” Jackson said. “The surgery isn’t going to make you look 22 again.”

Inappropriate candidates include those going through divorce or the loss of a spouse or job, those with expectations of perfection, people who surgeon hop until they hear the answers they want and those obsessed with minor defects.

Some people suffer from a condition called body dysmorphic disorder (BDD), said Linton. “They become obsessed with a part of the body that they feel is not the way it should be. They may look at it in the mirror seven times a day and stare at it for hours. These people have a distorted view, like looking in a fun-house mirror. They cannot be consoled. They don’t respond to repeated assurances, not even from medical professionals.

“Michael Jackson is a perfect example of plastic surgery gone awry,” he said. “He might have BDD.”

“One of the arts of being a plastic surgeon is recognizing people who may have an addiction or have the wrong motives,” said Andy Stewart. “There are times when you have to tell people no, or point out that they have a body-perception problem.”

Lunch break beauty

The biggest trend in the quest to quell aging, particularly among younger people, embraces such nonsurgical procedures as Botox, laser treatments and skin fillers. Many of the lesser procedures can be performed over a lunch hour.

But they can be disappointing. A patient who underwent laser resurfacing said the treatment didn’t live up to her expectations. “It didn’t get rid of those fine lines and wrinkles, and it was hard to recover. The first 72 hours were horrific. I was oozing like I had a third-degree burn. I wouldn’t recommend that to anybody.

“My skin is smooth, as far as tone and not having breakouts anymore,” she said, “but the fine lines and wrinkles are still there.”

Still, the idea of a quick, cheaper fix proves irresistible. According to the ASAPS, such surgical procedures as liposuction and face-lifts increased 12 percent from 2002, but Botox, wrinkle fillers and chemical peels jumped 22 percent.

In December, the FDA approved the filler Restylane, a hyaluronic acid that contains a natural skin component and lasts twice as long as traditional collagen, a cowhide derivitive.

“I’ve probably done a dozen Restylane cases,” Stewart said, “and they leave here looking great. But let’s see if it lasts as long as it’s touted to.”

Restylane doesn’t replace a face-lift, he said, and a face-lift can’t do what Restylane can do. A face-lift doesn’t remove wrinkles around the mouth, and that’s one of the biggest indications for Restylane. They’re complimentary rather than exclusive.”

Surgeons often combine fillers with Botox. Injected into a muscle, it blocks nerve signals that cause the muscle to contract. The frown furrow or wrinkle vanishes because the muscle responsible for it is paralyzed. Effects last three to six months.

Botox and fillers give instant results and don’t require lengthy recovery periods, but continual followups over the years can prove costly.

“We charge by the syringe,” Stewart said. “A syringe of Restylane is $600. Most of the time, we use one syringe or less. For deep folds, it’s going to take more.”

“In my 13-year career, I’ve seen things come and go,” Jackson said, “and I’m not crazy about fillers. Remember the margarine commercial, ‘It’s Not Nice to Fool Mother Nature’? When you inject something that’s not their tissue, you are going to pay. It can be dissolved, spit out or surrounded by scar, and that’s uncontrollable.

“A person’s own fat is the best thing, but it dissolves and needs to be replaced.

“The big impetus is on alteration of the skin, trying to change the nature of the skin’s own collagen using things like radio frequency and intense-pulsed light,” Stewart said. “All these things are trying to heat the collagen and cause it to tighten so there will be less drooping and less wrinkles. If we can find a way to do that without causing any harm, that will be a revolution.”

To contact staff writer Sandy Wells, use e-mail or call 348-5173.

Coming this week

Stories by Sandy Wells in The Charleston Gazette and Sunday Gazette-Mail:

s Monday: Brow-lift

s Tuesday: Tummy tuck

s Wednesday: Breast implants

s Thursday: Liposuction

s Friday: Rhinoplasty (nose job)

s Saturday: Blepharoplasty (eyelid surgery)

s Sunday: Face-lift


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