| Ilena Rose 2005-01-09, 7:12 pm |
| Published January 3, 2005
Rebuilding You
As cosmetic surgery becomes more acceptable and procedures increase,
experts weigh risks and rewards.
http://entertainment.news-leader.co...ing-264980.html
Graphic by Jeff Harper, News-Leader
Dr. Paul Nassif injects Botox into the forehead of Lisa J. Davis in
Los Angeles. Botox, a muscle-paralyzing neurotoxin, is one type of
cosmetic procedure used to reduce facial wrinkles.
Associated Press Photo
To learn more about breast implants, visit:
• www.center4research.org
• www.breastimplantinfo.org
• www.fda.gov/CDRH/breastimplants
• www.implantsout.com.
To read about liposuction: • www.fda.gov/CDRH/ liposuction.
By Tresa McBee
News-Leader
A good day for Kacey Long is being able to get dressed and to class
without help. The day she wrote a two-page letter was a milestone. At
one time, she couldn't sign her name.
Long got saline breast implants when she was a healthy, athletic
19-year-old. Shooting arm pain began immediately. Every joint ached.
After seeing multiple doctors, Long, of Ennis, Texas, was diagnosed
with rheumatoid arthritis and arthritis of the neck and spine — both
are autoimmune diseases — as well as fibromyalgia (which affects
connective tissue) and chronic fatigue syndrome.
Believing her implants were the problem, Long, now 22, had them
removed in fall 2003. She immediately felt better, though she remains
disabled and unable to work or live alone.
Jeanie Simmons had saline implants when she was 32. After two
pregnancies and breast-feeding, Simmons, of West Plains, was unhappy
with how she looked.
She'd contemplated surgery for a few years and researched doctors,
clinics and the procedure. She got the implants in February and was
back to work in a few days. Other than the usual swelling that went
away after six weeks, Simmons, now 33, hasn't had problems.
Long and Simmons are two of the almost 7.2 million women who had
cosmetic procedures in 2003 — a 16 percent increase from '02,
according to the American Society for Aesthetic Plastic Surgery.
Liposuction was the No. 1 surgery, with breast augmentation next.
Men had nearly 1.1 million procedures, a 31 percent increase from '02.
Liposuction also was the most popular.
Women ages 19 to 34 had 24 percent of procedures. People 35 to 50 had
the most at 45 percent.
And though they are a small percentage of the total, people 18 and
younger are getting both surgical and nonsurgical cosmetic procedures.
According to the ASAPS, 223,594 total cosmetic procedures were done in
that age group in 2003.
As the number of cosmetic procedures increases, experts urge those
considering such changes to closely review the benefits and dangers.
The age factor
All patients must be screened for realistic expectations, but
assessing young patients takes extra care, said Dr. Leroy Young, a
25-year plastic surgeon in St. Louis and a spokesman for the American
Society of Plastic Surgeons.
"For young people who want to have plastic surgery, they need to be
aware of the risks and the long-term complications," Young explained.
"Therein lies the dilemma. Usually at that age, they don't have the
depth of experience."
ASPS recorded a 48 percent increase in total cosmetic procedures in
people 18 and younger in 2003 from '02.
Rhinoplasty (nose job) and otoplasty (reducing ear size) are among the
top surgeries, while chemical peels and microdermabrasion are popular
nonsurgical procedures.
But it's the breast implant numbers that alarm some.
ASAPS indicates 11,326 augmentation procedures were done on women 18
and younger last year, a three-fold increase from 2002.
The Food and Drug Administration has approved saline breast implants
for women 18 and older, though younger women can get them with
parental consent, said Diana Zuckerman, president of the National
Research Center for Women & Families in Washington, D.C. Zuckerman,
who has a doctorate in psychology and did post-graduate training in
epidemiology, is a well-known critic of implant safety.
"We get letters every day ... from women with breast implants," she
said. "We hear from other women with plastic surgery problems and
other problems as well, but nothing compares to breast implants."
"We're not opposed to all plastic surgery," she continued. "We're ...
very concerned about the broader issue of how our image of perfection
of body and face have changed."
Zuckerman's concern extends to all women, but she's especially worried
about young women with young bodies that will likely gain weight
between 18 and 22.
"I think that's very important that these girls are not done growing.
.... Five, 10, 15 pounds will usually add a little cleavage. Maybe not
a lot, but some, and for a lot of women, it's enough."
Breast Implant history
Silicone gel implants have been around since the early 1960s; saline
implants have been available since about the early '70s, Zuckerman
said.
Silicone implants have a silicone shell and silicone gel filling.
Saline implants have a silicone shell and salt-water filling.
Silicone is used because it's one of the most biocompatible products,
Zuckerman said.
When implants were introduced, the FDA had no regulatory authority
over any medical devices. That changed in 1976, and there was a huge
backlog of devices needing evaluation.
Everything from latex gloves to heart valves was categorized by how
safe they were considered, with devices like heart valves taking
initial attention, Zuckerman said.
Breast implants were first placed in the safe group and eventually
moved into the "we're very concerned" category, she said.
In 1991, the FDA required manufacturers to provide data on silicone
gel implants.
Meanwhile, during depositions for a California lawsuit regarding
silicone gel implants, documents expressing safety concerns that
weren't given to the FDA were discovered.
A reporter was present and got copies. Zuckerman was among the first
to see them.
People assume "a company isn't going to hide problems," she said.
Silicone gel implants were restricted in 1992, usually for use in
women with cancer, abnormalities or who have had a silicone gel
implant break.
In 1999, the FDA required data on saline implants — just as it had for
silicone — and approved saline in 2000. The lag time dates to the
backlog created in 1976.
"It's a very unusual situation," said Zuckerman of the
implant-approval process.
It's a process that illustrates how the FDA still functions as it did
in the 1930s when medical devices were few and medications weren't
taken long-term, Zuckerman said. The FDA doesn't usually require
long-term safety data, she added.
She points to recent problems with arthritis medications Vioxx and
Celebrex.
"If a product is going to be used long-term, it should be studied
long-term."
Are implants safe?
Whether breast implants are safe depends on who you talk to and what
you read.
There are stories of healthy women, many in their 20s and 30s, who
became ill, often disabled, with autoimmune problems after getting
implants.
Silicone gel implants cause the most concern, though there are people
like Long who have serious problems after getting saline.
"I think, generally, saline implants are a safer choice, but they're
not a safe choice, because some women will have problems," Zuckerman
said.
Plastic surgeon Young implants both silicone gel and saline and
believes they're safe.
"There's no good evidence to support (they're unsafe)," he said. "I
don't see anything to suggest that's the case, and it's been studied
to death. There have been over 20 epidemiological studies to date, and
none have shown a link."
Zuckerman disagrees. Most studies — many funded by manufacturers —
studied women with implants less than five years, she said, and most
problems take longer to appear.
"There have been more than 20 studies, and they have not shown a link.
That's true," Zuckerman said. "The best studies — the ones that
studied women who had implants for at least six years — and those
studies done by government scientists — who are the ones studying
women with implants for at least six years — have shown problems."
According to the FDA, implants will not last a lifetime and will
likely need to be replaced at least once. Many changes from implants,
such as stretching, can't be undone.
And local complications — breast pain, hardening of scar tissue,
rupture and deflation — occur often enough to be a concern, the FDA
reports.
Long said her board-certified surgeon never discussed risks.
"They said the only time I'd have to get them replaced is if I wanted
to go bigger, if I wanted to get silicone gel implants. When you hear
that, that pretty much knocks out a lot of questions."
Long said she was too young to get the procedure her parents were
against.
The implants cost $4,500, of which she still has $1,300 left to pay.
Removal cost her parents $6,400.
Long thought herself bottom-heavy. She was a B cup before surgery and
a D cup after implant removal. "I didn't know (my breasts) were going
to develop into my 20s," Long said. "If I'd known that, I would have
waited. Definitely. I just thought, the FDA has approved for women 18
and over."
Zuckerman applauds ASPS' recent statement that implants for aesthetic
reasons only shouldn't be done on women under 18. "We think, really,
they shouldn't do it on anyone under 21, because they're still
growing. ... It's a step in the right direction."
Risks and long-term considerations are "about a 45-minute discussion,"
said Dr. Michael Harl with The Center for Plastic Surgery at
Ferrell-Duncan Clinic.
"That's one thing I really emphasize. ... You have to view breast
augmentation as a maintenance program," Harl said. "Breast implants
are man-made and will fail at some point. ... There are some women
walking around with them for 20 years, but I think that's the
exception."
He believes implants are safe.
"I think the FDA studies have been pretty conclusive about that," Harl
said.
Simmons, whose implants were done by Harl, said she was told she'd
likely face re-operations. "You don't think about getting implants at
50 or 60," Simmons said. "I wonder how that'll go."
Without any complications so far, she's thrilled.
"I don't regret it at all. ... I would recommend it."
Benefits vs. reality
Harl approaches teenage patients with caution.
"I don't do a lot of cosmetic surgery in people that young. ... Unless
they have some functional abnormality going on, I'd usually encourage
them to wait a little bit. I tend to run a little conservative."
Although ear surgery provides a cosmetic benefit, Harl views
procedures like that as reconstructive.
"For psychological reasons, that one has a lot of benefits."
And such benefits can't be overlooked, Harl said. Critics of plastic
surgery may not realize the line between cosmetic and reconstructive
surgery isn't so distinct, he said.
"So many of these women, you really do change their outlook on life.
It's hard to view it as a trivial procedure. ... It has its place."
Zuckerman agrees — up to a point. Safety aside, she's concerned
teenagers, or even older woman, don't realize what famous faces go
through, including digital alteration.
"We're surrounded by these women with unnatural bodies," Zuckerman
said. "Very thin bodies, very large breasts. These bodies don't occur
in nature — very rarely. ...
"And then we, the consumer, look at the cover girl and wonder, 'Why
don't we look like that?' Well, we're never going to look like that,
because even they don't look like that."
Cosmetic procedures
Forehead lift $2,797 average fee 1-2 hours 57,771 patients
BotoxOinjection $376 average fee 30 minutes 2,891,390 patients
Ear surgery $2,535 average fee 2-3 hours 26,612 patients
Eyelid surgery $2,525 average fee 1-3 hours 246,633 patients
Chin augmentation $1,693 average fee 1 hour 16,306 patients
Breast augmentation $3,375 average fee 1-2 hours 254,140 patients
Breast implant removal $2,047 average fee Time not available 45,147
patients
Breast lift $3,857 average fee 1.5-3.5 hours 66,638 patients
Liposuction $2,224 average fee 45 minutes-2 hours 320,022 patients
Buttock lift $3,554 average fee 2 hours 2,411 patients
Nose job $3,188 average fee 1-2 hours 356,554 patients
Facelift $5,283 average fee 2-3 hours 128,667 patients
Cheek implant $2,083 average fee 2 hours 12,112 patients
Collagen $373 average fee Less than 1 hour 576,255 patients
Lip augmentation $1,325 average fee 1 hour 22,667 patients
Upper arm lift $2,809 average fee 2 hours 6,890 patients
Chemical peel $607 average fee 30 minutes-3 hours 995,238 patients
Tummy tuck $4,641 average fee 2-5 hours 101,228 patients
Thigh lift $3,283 average fee 2 hours 5,615 patients
SOURCE: AMERICAN SOCIETY OF PLASTIC SURGEONS; AMERICAN SOCIETY FOR
AESTHETIC PLASTIC SURGERY. STATISTICS ARE FOR 2003. DOLLAR AMOUNTS ARE
AVERAGE SURGEON FEES ONLY
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