Cosmetic Surgery No Longer Subject of Taboo

Dec 16, 2010/NewsRelease/ – The generation of peace, love, and change embarks on the main telecomutting saves gas as the oldest from the baby boomer generation turns 65 January, 1, 2011. Marked rich in divorce rates, competition in the work place by millennials, and the emergence from the “cougar”, the baby boomer generation has changed the bend on aging unlike previous generations. In 2009, the American Academy of Plastic surgery reported over 17 million cosmetic procedures performed in the usa, the majority of which contributed through the aging baby boomer population. Top procedures reported amongst baby boomers included: blepharoplasty, liposuction, abdominoplasty, and anti-aging treatments such as Botox.

Texas physician, Dr. Michael Escobedo of Escobedo Esthetics, “No 1 really wants to look like their neither parents nor grandparents generation. Nowadays, baby boomers need to compete with younger generations with the work place, but in the dating arena. Our objective would be to not only get people to look younger, but to allow them to regain the confidence they once been on their youth.”

This past year alone, Dr. Escobedo’s top cosmetic process was liposuction, performing over 200 treatments last year alone. Nearly 3/4th of Dr. Escobedo’s patients fell within the age range of 35-64. These alarming numbers in cosmetic surgery impact not only baby boomer aging habits, but alter the standard of cosmetic surgery from a once subject of taboo for an accepted aging preventative for proceeding generations.

One patient, who chose to remain anonymous, remarked, “I’m old, and I’m not trying to look like a twenty something. I would like to look very good and feel confident once more.”

Ultimate payback after a breakup? Plastic surgery

Forget “Bridalplasty.” The real money is in “surgical vengeance.”

The reality show in which women compete for pre-wedding cosmetic surgery may be getting all the attention, but doctors who ply their trade sculpting bodies and faces know that just as many – if not more – of the patients walking through their doors are motivated not by a new union but a marital breakup.

“There are a lot of women who come in either pre- or post-divorce who are looking to make themselves feel a little bit better,” says Michael D. Cohen, medical director of the Cosmetic Surgery Center of Maryland. The whole story might not come out at the beginning, he says, but once he gets to know a patient, he often starts to hear details of a split.

Two weeks ago he did a tummy tuck and eyelid lift on a woman just out of an 37-year marriage, followed by breast augmentation for a woman in her 20s who found out her husband had cheated on her. “She suggested to the people preparing her for surgery that it was sort of payback,” he said.

Hence the nickname the procedures have gained: “vengeance plastic surgery.” It’s become so popular with physician Stephen Greenberg’s clients in New York City that he developed a “divorce package” that gives patients a slight discount if they’re coming off a breakup. (And it’s not just women; Greenberg estimates that 30 percent of the patients taking advantage of the plan are men.)

Ann Soriano wasn’t thinking about revenge. The New York City woman’s husband left after 17 years of marriage, she says. They were separated for several years before she filed for divorce seven months ago. Five months later she walked into the offices of Joseph Eviatar.

“I lost a lot of weight, just from the stress of it all. And if you lose weight because you’re eating well and exercising, it looks good. If you lose weight because somebody walks out on you, you don’t look so good,” says Soriano, a 49-year-old office manager. After a round of Restalyne injections, she’s feeling better about her appearance and contemplating liposuction for her midsection.

“I was just like, ‘Jeez, I don’t want to grow old by myself. So I’ve got to throw myself out there and see what happens,’ ” she says. “And the first thing [people notice] is the look, unfortunately.”

Phil Haeck says that’s a common theme among his patients: “I’m going back on the market and I’m afraid how I look right now isn’t going to work.”

Haeck, president of the American Society of Plastic Surgeons, says he has two major concerns about clients seeking treatments in the midst of a divorce: They’re making weighty decisions during an emotionally unstable time. And they sometimes expect that plastic surgery will immediately alter their circumstances in life.

“There’s a discussion that has to be had – do they expect to find Superman or Superwoman the next day after they change their appearance? Because that person may not suddenly drop into their lives just because they’ve had something done,” says Haeck, who practices in Seattle.

But, he adds, in the best cases cosmetic procedures give newly single patients an extra shot of confidence as they wade back into the dating pool. “There may be subtle things that happen in terms of their openness to talking to strangers,” he says.

Soriano thinks that might be the case for her. “It’s time,” she says. “Not necessarily to get married again – but to go out, to find companionship.”

Doctors remove lower jaw, reconstruct it from leg bone

JAIPUR: Doctors at SMS Hospital reconstructed the lower jaw of a patient after it was removed along with a massive tumor. It took surgeons at the plastic surgery ward nearly six hours to remove the nearly two kilogram tumor and reconstruct the lower jaw from the fibula bone of the patient. The patient, after undergoing the complex surgery on Monday, is showing steady recovery at the intensive care unit of the hospital.

“The tumor of the patient had grown big and the lower jaw had to be removed. At the same time, it was necessary to restore the removed part replaced to enable the patient lead a normal life,” said Dr Pradip Goyal, professor of plastic surgery.

The patient, Imarta, a 50 -year-old man from Baran district, had been suffering from the tumor for almost four years. The tumor was due to bone cancer and had spread to most part of the lower jaw. Nearly a 10 x 15 centimetre in size, the tumor had caused the lower jaw of the patient to bulge out.

It was, however, the financial constraints that prevented Imarta to gain access to treatment earlier. A below poverty line patient, he was brought to SMS hospital on November 25. The cancer has spread to a major part of the patient’s face and he was referred to the plastic surgery department. The doctors decided to remove the tumor surgically; they also had to remove the lower jaw as the bone was surrounded by the cancerous growth. It was also the jaw bone that the doctors suspected to have caused the cancer.

Absence of the lower jaw bone would have made life more complex for the patient and the doctors thought to reconstruct the entire jaw through another bone. The entire treatment was performed free of cost at the hospital as a further delay in treatment could have been threatening to the patient’s life.

“It is difficult to predict the exact cause of the cancer. However, it was developed around the bone and continued to spread in negligence of the early symptoms,” said a doctor. “However, after the surgery, the tumor has been completely removed and the patient is showing good recovery, it will take him a few months to get adjusted to the reconstructed bone but he will be able to live a normal life,” he added.

Are Toes The New Nose?

For a growing number of women who want to strut their stuff in high heels, the latest footwear fashion accessories are surgical saws, titanium rods and liposuction needles.

Toe shortening and fat injections into the foot pad are among the popular procedures in a new plastic surgery craze focused on feet. Paying up to $3,000 per procedure, more and more women are surgically transforming themselves into Cinderella from the ankle down. Helping women squeeze into high heels — and curing the damage they cause — is a $45 million a year business.

“All the girls are wearing cute high heels, open toes and they look pretty, and me — I have to wear always closed shoes because I feel like they’re staring at my long toe,” Audy, who asked to be identified by first name only, told ABC News. She was awaiting cosmetic surgery to make her second toe shorter than her big toe.

Watch the full story on “Nightline” tonight at 11:35 p.m. ET

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Podiatrist Ali Sadrieh in Beverly Hills, Calif., performs the toe shortening procedure, which involves actually dislocating the toe and sawing out a 2-millimeter chunk of bone. He then inserts a titanium rod to bring the shortened bone back together.

Another procedure gaining traction in the world of foot facelifts plumps up the bottom of the foot to make high heel wearing more comfortable, like permanently installing a Dr. Scholl’s pad. It involves liposuctioning fat from a patient’s belly and injecting it into the balls of the feet.

And then there is the ever popular pinky toe tuck, in which fat is taken out of the little toe to make it narrower.

While cosmetic surgery on the feet is trending high with women as a permanent solution for their footwear crises, it is largely frowned upon by The American Podiatric Medical Association and officially opposed by the American Orthopedic Foot and Ankle Society (AOFAS) because of risks and complications of the operation. Potential problems include permanent nerve damage, infection, scarring, a recurrence of the deformity that was supposedly fixed and chronic pain when wearing not just high heels, but all shoes, according to the AOFAS.

Answering Call of Manolo Blahnik: Cosmetic Surgery For Feet

Still, the call of Manolo Blahnik is irresistible to many women who are willing to accept the risks as the price of fashion. Dr. Sadrieh says he stands ready to scrub and assist them in answering that sartorial siren song.

“It’d be an ideal world if we could synthesize some engineering, some beautiful design and some medical knowledge into one ball and relinquish these women from the suffering that they’re having every day. Until then, I’ll keep fixing them,” Sadrieh said.

The agony and the ecstasy of footwear has existed since 1000 B.C., when women started wearing high heels to convey social status and sex appeal. The earliest version of stilettos was discovered in the tombs of ancient Egypt.

The hankering for high heels continues today and is sending Dr. Sadrieh’s patients like Audy, who sought toe shortening surgery, and Kelly, who wanted fattened foot pads. Both patients asked to be identified by first name only.

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Examining Kelly’s feet before the procedure, Sadrieh told ABC News, “This is a nice thick callous she’s got. It’s exaggerated or exasperated because of the shoes and the function of the foot. So this callous is really the target spot of fat injection. This band right here really is where all the fat is going to go.”

He then liposuctioned fat from her belly and injected it into the spot. Afterward, Kelly experienced some normal swelling — jokingly referred to as “toebesity.” The swelling was expected to go away and leave her with a small pocket of fat to pad her weary feet.

After the procedure, Kelly told ABC News that the podiatric makeover was a “piece of cake. I can feel the pillows in my feet. It’s like puffy pillows.”

Audy, meanwhile, completed her surgery and ended up with a second toe that is finally shorter than its larger neighbor.

Sadrieh will likely remain busy since nosebleed-inducing heels appear to be the height of fashion. This year’s runway darling was a shoe with a 12-inch heel, nicknamed the “skyscraper sandal,” from Romanian designer Mihai Albu.

Fashionable or not, the human foot is clearly something near and dear to Sadrieh’s heart and he says he is a man who loves his work.

“I don’t have a foot fetish, but it’s what I do,” laughed Sadrieh. “I’m always looking at feet — it’s like a software programmer, always checking out the code. Or an auto body guy saying, ‘Did you (see) that car?’ I can’t help it. It’s what I do. I look at feet. And I think we can’t discount the fact that there is a sexuality to the foot.”

Why fat soldiers get plastic surgery

The latest new patients for plastic surgeons are overweight soldiers and high-heel wearers.

Army Times reports that soldiers are turning to liposuction to remove fat if extreme dieting, laxatives and other methods fail to get them under the Army’s weight limit for their height, age and gender.

“Liposuction saved my career. Laxatives and starvation before an [Army Physical Fitness Test] sustains my career,” a soldier told the periodical. “Soldiers are using liposuction, laxatives and starvation to meet height and weight standards. I did, do and still do”

The Army Times stated:

“Health experts say the number of soldiers using extreme weight-loss methods may closely resemble results of a recent study by two officers attending the Naval Post Graduate School. The study found that nearly one in three Marines have gone to such measures to lose weight.”

The publication said it found liposuction ads in numerous base newspapers, including those at Fort Benning, Ga.; Fort Campbell, Ky.; and Fort Hood, Texas.

HIGH-HEEL WEARERS

ABC News reports that increasing numbers of women, particularly high-heel enthusiasts, are getting plastic surgery on their feet.

Procedures include:

• Toe-shortening, if a toe looks too long.
• Pinky toe tuck, which removes fat from the small toe so the foot can fit into narrower shoes.
• Injecting fat from the patient’s belly into the bottom of the patient’s foot to serve as a pad so high-heels will be more comfortable.

ABC says plastic surgery on feet is “a $45 million a year business,” but does not cite a source for that figure.

52 is “best time” to get plastic surgery, says average woman

Most women think the perfect age to get plastic surgery is 52 years, 41 weeks and four days, according to a new survey. One in three women over 40 are so worried about their appearance that they would consider plastic surgery. The poll also found that a fifth of women between 40 and and 60 would happily get a face lift if they had the money.

Almost a third of those quizzed said they would rather look 20 years younger than be a millionaire.  Women aged between 40 and 60 also spent an average of £137.28 a year on anti-ageing creams.  An eye lift was the most popular choice for those who wanted plastic surgery with a quarter choosing this method to smooth out wrinkles while 29 per cent wanted a tummy tuck.

Even those who didn’t want cosmetic surgery wanted a helping hand with 29 per cent saying they needed Botox or chemical peels in the battle against ageing. The survey was conducted by Superdrug who polled 3,000 women between 40 and 60.

Low-cost Botox treatments raise some eyebrows

A South Tampa gym recently celebrated its grand opening with Botox shots for only $7, beating even the $10 deals also popping up this holiday season in places like medical spas and nail salons.

It’s a brisk business.

Last year, Americans lined up for 11 million minimally invasive cosmetic procedures — most often injections of the wrinkle-smoothing drug and its chemical cousin Dysport. The economic climate has discouraged people from getting plastic surgery, but not the subtler — and cheaper — enhancements.

Look no further than mall-based medspas for proof that many women and men now consider such treatments as essential to personal maintenance as coloring their hair. And fans are starting young: 30-somethings account for nearly one-fifth of the market, says the American Society of Plastic Surgeons.

As the holidays approach, competition is fierce for the gift many may be giving themselves. At AnuYou Institute in St. Petersburg, for example, customers can choose between popular $10 per unit Botox days and a 12 Days of Christmas promotion — buy 20 Botox units, get five for free.

But which is the better deal? And is it okay to get a medical treatment in a gym or spa?

“It’s buyer beware,” said Dr. Dan Greenwald, a plastic surgeon in South Tampa. “When you shop on price, the risk of Botox is really unreliability.”

Whether or not you like your results, the wrinkle-easing effects of the drug aren’t permanent. No matter who does it, you’ll need a refresher within months.

“It’s not that you’re going to have a dangerous outcome that you’re going to regret for the rest of your life,” he added. “It’s just that you’ll get an unreliable result — or a result that doesn’t last as long as you’d like.”

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The $7 Botox offer for Vibe Fit Club’s opening in South Tampa lured 42-year-old Melissa Sullivan from St. Petersburg. She had never tried Botox, but came with a friend who recommended the doctors offering the gym special.

“This is a good introductory price point for me,” said Sullivan, “and if I don’t like it, oh well, it wasn’t that much money.”

But even at $7 per unit, Sullivan said she spent $336 on her treatment. The effects — which she liked — should last at least four months, said Dr. Laszlo Teleszky.

Teleszky is a medical director at the Red Bamboo Medi Spa, based in Clearwater, which has a branch just off the main gym floor. He says Botox at a gym makes sense.

“You can come work out, tone your body, but you may have some wrinkles on your face you want to get rid of.”

Wherever it is given, Botox can only be prescribed by a doctor, physician assistant or a nurse practitioner. Any doctor can do it in his or her primary care practice; no specialized background in dermatology or plastic surgery is required.

But under Florida law, in a medspa — or any aesthetic center that isn’t the doctor’s primary office — the nurse practitioner or physician assistant must be supervised by a board certified dermatologist or plastic surgeon, though they don’t have to be present.

• • •

When you’re sick, and especially if you have insurance, you may not think to ask the doctor what treatment will cost. But consumers generally pay for cosmetic procedures themselves. Plus, there’s time to shop around.

Price wars in a competitive market like Tampa Bay can help you score a good deal — if you know how to shop for the product, and how to find a reputable vendor.

In 2002, the FDA approved Botox, a brand name for Botulinum Toxin Type A, to treat moderate to severe frown lines between the eyebrows. Now it’s used elsewhere on the face, too.

Costs vary nationally, but on average, a Botox session goes for about $400, according to the American Society of Plastic Surgeons. If you pay by the unit — and drugmaker Allergan charges doctors $525 for a 100-unit vial — you have a good idea what you’re getting. With pricing by the treatment area, however, you may not know how many units were given.

“The answer is, they just don’t give you very much. That’s the easiest trick in the world,” said Dr. James Spencer, a dermatologist who practices in the Carillon area of St. Petersburg.

“When you’re buying paper towels or something like that, of course you want to go to the cheapest place possible,” said Spencer, immediate past president of the American Society of Cosmetic Dermatology and Aesthetic Surgery. “But when you’re using a medication for your face, that’s not the time to cut corners.”

But even knowing the units used may not tell the whole story. Botox comes as a white powder that is mixed before use. The fresher the batch, the better the results. So you might get Botox that’s been in the fridge for days, or has been watered down. Or you might get a similar FDA-approved medication, Dysport, that’s a bit cheaper. It can yield slightly different results, depending on the area treated.

At the Venus Mini Med Spa, with locations in shopping malls in Tampa, Clearwater, Brandon and Sarasota, head physician assistant Rita Clarke finds that many people care most about looking good, not whether they get Botox or Dysport.

“If they’re not asking, we prescribe what we think is best. If they specifically want something, that’s what they get,” said Clarke, whose clientele has grown to more than 4,000 clients in a year and a half.

“People want a good price, a good result and they want it convenient,” Clarke added. “And that’s the bottom line of what we do in the mall.”

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At Bayshore Plastic Surgery, Dr. Greenwald will share a vial of Botox among no more than three patients coming in within two hours of each other. Patients can see him open the sealed vial. His per-unit pricing is competitive, but he requires that customers purchase at least half a vial for immediate use, so his treatments may be costlier than at some outlets.

“I’m probably more expensive than going to the mall,” he said, noting that Botox is a small part of his practice. “But what you get from that is a whopping good dose that’s fresh — and the reliability of me.”

Still, many health professionals can safely administer Botox, says Greenwald, who is also the medical director of Esteem Medspa in Tampa, where he has trained physician assistants and nurse practitioners to deliver Botox.

It’s a controversial topic. Spencer, the St. Petersburg dermatologist, says his training is a quality check for consumers, who should be concerned about general practitioners doing aesthetic work without specialty training.

Then there’s the perspective of Dr. Teleszky and Dr. Frank Toscano, the medical directors of the Red Bamboo Medi Spa.

Both trained as emergency room physicians, and each treated gunshot wounds and late-night emergencies for about 25 years. In 2008, they entered the beauty business, learning the art of Botox in a three-day, extensive course. They now spend most of their time on aesthetics, although both still take ER shifts.

“If a plastic surgeon spends his time doing breast enhancements, they are not going to spend nearly as much time and effort learning to do injections,” Toscano said. “We don’t deliver babies. We don’t take off skin cancers. And we don’t do jaw reconstruction. We’re aesthetic physicians.”

A spokeswoman for Allergan, the Botox provider, offered this guidance: “Only a licensed and trained physician who specializes in aesthetic medicine — like a dermatologist or a plastic surgeon — should administer Botox Cosmetic as this is a technique-sensitive procedure and one that should only be administered in a proper medical setting, like a doctor’s office.”

But in today’s marketplace, consumers make the final call.

“At some point, you just have to trust,” said Nancy Spencer of St. Pete Beach, who was comfortable receiving Botox from an experienced nurse practitioner at the AnuYou Institute in St. Petersburg.

Spencer bought AnuYou’s $99 Groupon deal on laser spider vein removal, and was so pleased she came back for a massage. She also took advantage of a recent $10 per unit Botox day, leaving happy with the results.

“I’m always looking to try different things and new places,” said Spencer, 53. “As long as they are going through the effort of giving me a good deal, then I will take them up on some of their other services.”

Shopping for cosmetic procedures

• You should be examined by a doctor, physician assistant or nurse practitioner — the only providers allowed to prescribe Botox.

• Check that your medical provider is licensed and review their disciplinary history on the state Department of Health’s website: http://www.doh.state.fl.us/MQA.

• Ask about the credentials of the provider.

• Get recommendations from friends and people you trust.

• Consider what could happen if you’re not satisfied. Is the provider well enough established that he or she will be there in a month to make things right? How long will the effects last? How serious could a poor outcome be?

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■Tighter, smoother skin…
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So people won’t think you’ve been away at surgery. They’ll think you’ve been away on vacation. To get started on your rested, rejuvenated look, please explore our site. Ready for a consultation? Call us today! 514-695-7450.

Plastic Surgery ‘Lifts’ Can Fight Gravity

The saying about old age being no place for sissies–most often attributed to Bette Davis–is so right. Along with more serious issues some women develop as the years pass, comes sagging of muscles, skin and fat as body tissues inevitably lose the battle with gravity.
  Life Many women are content to take good care of themselves and let nature take its course. Others intervene using non-invasive weapons like a prescription-strength skin care regimen and perhaps a little Botox. If neither of these approaches is aggressive enough for you, you may be a candidate for fighting back with a lift.

Here are the most popular plastic surgery “lifting” procedures women choose to combat the effects of gravity:

Eyelid lift: If you believe droopy eyelids make you look old and tired, you’re in good company. Blepharoplasty, as doctors refer to it, is the third most popular cosmetic surgery procedure. The operation removes excess skin from the upper eyelid to open up the eyes and restore an alert, youthful look. If you choose to have surgery on the lower lids as well, you can get rid of that puffy look too. Recovery is most often pretty easy, with patients experiencing scratchy, sore eyes for a day or two and bruising that fades over several days. Surgeon’s fees for blepharoplasty are around $2,700 (not including anesthesia, surgical facility costs and so on.)

Brow lift: Some women who consult a plastic surgeon about facial aging are surprised when their doctor recommends a brow lift. It’s just not easy to tell that, in many cases, the effects of gravity on the face start up at the hairline. A skilled plastic surgeon will be able to show you exactly what is making you look older than you feel, and it just could be a droopy brow. If you decide to undergo a brow lift, or forehead lift, there are a variety of techniques your surgeon may use to pull your skin up and anchor it in a more attractive position without giving you visible scars or a look of permanent surprise. You may have a headache for a couple of days after surgery, but other than that recovery is relatively smooth. Surgeon’s fees for a forehead lift average about $3,300.

Facelift: Though it’s not for lack of trying, researchers still have not come up with a way to rejuvenate the face that’s as effective and long lasting as a facelift. Of course, you will pay your plastic surgeon around $6,900 for a traditional facelift, and it will be one to two weeks before you feel ready to be seen in public. You can opt for less invasive treatment, such as dermal fillers, but you’ll be returning to your doctor’s office a couple of times a year for repeat injections. Surface treatment, like chemical peels, Thermage and fractional lasers, can also make your skin look younger. But none of these techniques actually reverses the effects of gravity, especially on your cheeks, jowls and neck.

 Saved My Life Breast lift: Gravity is cruel when it comes to the bust line—even more so for women with large breasts. Sagging breasts contribute to an old, frumpy look in two ways: they hug your chest wall and lie low instead of projecting outward in their formerly perky manner, and they probably cause you to wear baggier clothing. Should you decide to have your breasts lifted, in a procedure called mastopexy, your plastic surgeon will make a lollipop or anchor incision around your nipples and down, excising a “V” of skin from below and boosting your breasts back higher. You’ll need to rest for a couple of days, then gradually add light activities back into your routine. Most women can return to work in a week. Mastopexy costs around $4,400 in surgeon’s fees.

There are other plastic surgery procedures that help patients do battle with gravity: arm lifts and thigh lifts are two. But those are less commonly performed and most often chosen by people who have lost massive amounts of weight. If you feel your age is starting to show and you don’t like it, you do have the option to visit an experienced, board certified plastic surgeon for help in the war on gravity.

Under the Knife or on the Couch? When Narcissism and Plastic Surgery Collide…

The word “narcissist” has become a popular choice to describe all sorts of perceived personality flaws, and many times it is used incorrectly. A person may have narcissistic tendencies but not the full-blown disorder. There is a narrow border between a conceited, boastful individual and one who has a true narcissistic condition. Plastic surgeons have an inordinate amount of contact with patients with this disorder because of what we do. The nature of cosmetic surgery deals with the process of altering one’s appearance in an effort to look better. Patients with narcissistic personality disorder are drawn to our offices not so much to improve their looks, but more importantly to garner attention from others.

Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance and a deep need for admiration. Those with this disorder believe that they are superior to others and have little regard for other people’s feelings. But behind this mask of ultra-confidence lies fragile self-esteem, vulnerable to the slightest criticism.

Sigmund Freud and other psychoanalysts of his time coined the phrase “narcissist” after the character in Greek mythology, Narcissus. He was the pathologically self-absorbed young man who fell in love with his own reflection in a pool. Freud believed that we all have some degree of “healthy narcissism” within our personality to garner self-esteem. Freud suspected that the personality disorder was simply a magnified extreme manifestation of this healthy narcissism. A highly confident individual with strong self-esteem is not a narcissist, but the line drawn between that person and a narcissist can be quite narrow.

My perception of Freud’s “healthy narcissism” is what I call “healthy vanity.” A person with healthy vanity has a high-level of self-assurance and a solid comfort with himself or herself. You try to look and feel your best because of pride and self-esteem. Healthy vanity allows you to be able to see and work with your good and bad points to the best of your ability. It means having a realistic and healthy view of yourself (good and bad!) and others around you. Healthy vanity means that you don’t value yourself more than you value others! A person with healthy vanity may spy their reflection in a mirror while passing by and comment, “Hey, I look pretty darn good today!” A narcissist will look in the mirror and say, “I don’t know what I would do if I weren’t so good-looking!” Healthy vanity is a positive and healthy trait.

My mother had a large dose of healthy vanity. She lived well into her 90s and never missed her weekly trip to the hairdresser, because she always wanted to look her best. She conceded that she was getting on in years, but that time spent each week on herself made her feel better and, more importantly, more confident. Self-esteem should not have an age barrier!

A narcissist, on the other hand, is someone obsessed with looks, status or anything that can be lorded over others who are less fortunate. They often monopolize conversations, have a sense of entitlement, and can become angry and controlling if they perceive that they are not getting what they want or deserve. They have to have the best of everything, the most expensive car, and socialize in perceived elite circles. They can be perfectionists to a fault, and expect constant praise and admiration. Narcissists are often notoriously unable to understand that their inflated views of themselves verge on the pathological.

Our super competitive society feeds this disorder. Many patients diagnosed with narcissistic personality disorder are first seen by plastic surgeons. A study performed in 1999 examining 133 patients requesting cosmetic surgery of the face revealed that 25 percent of these patients had extreme narcissistic tendencies!

It is for this reason that plastic surgeons must carefully evaluate each patient and rule out this disorder before operating on them. Pointed questions during the initial interview with a new patient can be instrumental in determining whether the patient is a realistic candidate with realistic expectations for cosmetic surgery or one with extreme narcissistic tendencies who will never be satisfied with the operation, no matter how successful. It is so important to understand exactly each prospective patient’s motives and expectations for surgery. Patients who mention extremes with regard to their reason for requesting surgery raise a red flag. One example is the petite and attractive young lady who presents for breast augmentation and desires DDD sized implants so that she will turn heads when she walks into a room. She already has a fine figure but just wants to do something to be noticed, not for her, but for an external quality. Or the chap who has a small bump on his nose and just wants 1.4 mm removed (no more, no less!) and expects a guarantee of perfection with the postoperative result.

Cosmetic surgery is not the treatment for people with severe narcissistic tendencies, and they must be referred to qualified mental health professionals to deal with the abnormality. Narcissism is a psychological issue that should be addressed. It is, at the very least, a serious personality flaw, or, in worst cases, a recognized psychological disorder. Its antisocial aspects can have an extremely negative effect on a sufferer’s daily life, personal relationships, and performance at work.