Suffering for their art.. A new exhibition compares depictions of military surgery now and 100 years ago

ENTERING the small room that houses “War, Art & Surgery” at the Hunterian Museum in London, the visitor encounters two images hung one above the other. On top, in sepia tones, is “The Birth of Plastic Surgery” (pictured), painted in 1916 by Henry Tonks; below, strikingly similar though tinted in the blues and greens of the modern operating theatre, is “Hands, hands, hands”, by Julia Midgley, a contemporary artist. Her work has been paired with Tonks’s in this thoughtful show marking the centenary of the start of the first world war. The public might be forgiven for growing a little weary of the anniversary, but here at the Royal College of Surgeons, the subject is approached in an unusual light.

Tonks, who was a surgeon himself as well as a subtle and perceptive artist, was not indulging in hyperbole in his painting’s title. The image depicts the operating theatre of Harold Gillies, the pioneer of facial reconstructive surgery. The two first met at the Cambridge Military Hospital in Aldershot, where Gillies was developing the techniques that laid the foundation for modern surgeons’ ability to rebuild the human face, using as his subjects the young men who had been horribly disfigured in the trenches.

“The Birth of Plastic Surgery” gives way, in this exhibition, to a wall of the remarkable pastel drawings Tonks made of the soldiers’ injuries. (The exhibition catalogue also shows photographs of the wounded and the work performed on them; it, much more than the exhibition, is not for the faint of heart.)

Tonks’s drawings, which have rarely been seen together in this way, are both accurate and humane. The eyes gazing out of shattered faces show confusion, fear—and then, just sometimes, when the surgeon’s work has been completed, hope, as in the images of Robert Davidson, who was serving as a medical orderly when he was wounded in 1916, losing his whole upper lip and left cheek. Gillies’s work enabled Davidson to “speak his native brogue again”, as the surgeon noted.

Opposite Tonks’s images hang those of Ms Midgley, who retired last year as Reader in Documentary Drawing at Liverpool School of Art & Design, and who previously worked as artist in residence at the Royal Liverpool and Broadgreen University Hospitals Trust. For this project, which “doffs its cap to Tonks”, as she says, she spent time not only with wounded servicemen and women at Headley Court in Surrey, where the Defence Medical Rehabilitation Centre is based, but also at Strensall Camp in Yorkshire, observing “Hospex” training—simulations in which amputee actors, equipped with elaborate prosthetics and body paint, help train military medical personnel to evacuate the wounded from Afghanistan and other conflict zones. And it was at the Royal College of Surgeons itself that she observed high-intensity refresher courses for army surgeons. Her work is not as graphic as that of Tonks, not least because facial injury is much rarer in 21st-century warfare. Improvised explosive devices are modern war’s most destructive weapon, so much of Ms Midgley’s work focuses on limb amputation and its after-effects.

Tonks did not think that his work should be exhibited. “They are, I think, rather dreadful subjects for the public view,” he said. But the Hunterian Museum, with a collection that bridges the worlds of art and science by illustrating the history of surgery and people’s fascination with their own anatomy, provides a thought-provoking setting. Ms Midgley’s delicate but forceful work is proof, if such were needed, that the courageous eyes into which Tonks looked so clearly still hold the artist’s gaze 100 years later.

“War, Art & Surgery” is at the Hunterian Museum, in London, until February 14th 2015


Excess Skin Removal After Bariatric Surgery Helps Keep the Weight Off

By Megan Brooks October 15, 2014

is_141016_bariatric_surgery_obese_800x600NEW YORK (Reuters Health) – Obese patients who have plastic surgery to remove excess skin after bariatric surgery may be more apt to keep the weight off than those who don’t, a new study hints.

“As plastic and reconstructive surgeons, we are encouraged by the idea that improved body image can translate into better long-term maintenance of a healthier weight, and possibly a better quality of life for our patients,” senior author Dr. Donna Tepper, a plastic surgeon with Henry Ford Hospital in Detroit, Michigan, said in a statement.

She presented the results October 11 at the annual conference of the American Society of Plastic Surgeons in Chicago.

The researchers followed 94 patients who underwent bariatric surgery at Henry Ford from 2003 through 2013, including 47 who subsequently had body recontouring procedures.

“While both groups lost a significant amount of weight at six months, as expected, those that underwent further contouring surgery maintained their weight at two and a half years. That’s pretty remarkable,” Dr. Tepper noted in an interview with Reuters Health.

The average decrease in BMI at 2.5 years was 18.24 in patients who underwent contouring surgery, compared with 12.45 in those who did not have further surgery. This difference was statistically significant (p=0.004).

“Bariatric surgery has a measurably significant positive impact on patient illness and death,” Dr. Tepper said. “However, even with the technical and safety advancements we’ve seen in these procedures, their long-term success may still be limited by recidivism. There is a high incidence of patients who regain weight after the surgery.”

She told Reuters Health that in her experience, many patients who undergo bariatric surgery are motivated to have excess skin removed and reshape or recontour their bodies and the current study suggests it can help with weight maintenance.

Dr. Tepper noted that insurance companies will typically cover aesthetic surgery after bariatric surgery if the patient had lost at least 100 pounds excess weight and were weight-stable for six months, in addition to meeting a few other criteria, such as having chronic skin irritation or rashes, or limitations in activities of daily living because of the excess skin.

The current findings, she said, suggest that plastic surgery following bariatric surgery may contribute to better long-term results.

In an interview with Reuters Health, Dr. John Morton, from the Stanford School of Medicine in California and President-Elect of the American Society for Metabolic and Bariatric Surgeons (ASMBS), said, “Now that bariatric surgery has been shown to be very safe and very effective, the number of patients has increased and some patients are going to need some sort of reconstructive surgery. It’s been a fast-growing part of plastic surgery.”

He emphasized, “Not all patients will need reconstructive surgery after bariatric surgery, but for those that do need it, it is important that they get it and I’m glad to see this (study) helped demonstrate that.”

“I do see it as reconstructive; there is nothing aesthetic about it. It is truly for function,” Dr. Morton said. A lot of patients who lose massive amounts of weight have redundant skin that can lead to pain and repeated skin infections, he explained.

There is also an impact on body image that can keep people from exercising. In that regard, “this study is a very important one and something we’ve seen in practice, but hasn’t really been described before, which is when you remove some of those barriers to exercise, good things will happen, like seeing more weight loss,” Dr. Morton said.

A plastic surgeon weighs in on the changing faces of celebs

“Who’s that girl?”

That’s the question many were asking when a woman with Renée Zellweger’s toned body and sleek dress sense — but not her familiar face — posed on the red carpet with the actress’ boyfriend of two years. Turns out it was Zellweger on Doyle Bramhall’s arm — only instead of her trademark deep-set eyes and smirky grin, the 45-year-old actress had wide saucers and an eerily smooth complexion.

Zellweger is the latest example of a disturbing trend: women — and occasionally men — in the public eye who, in the process of “refreshing” or “maintaining” their appearance, go a few millimeters too far and erase or minimize the very features that made them famous in the first place. The result? A generic, fabricated Hollywood look that has sadly become all too common.

“Surgeons are always well-intentioned, but sometimes they’re a little bit too formulaic in the procedures they use,” said Dr. David Hidalgo, a New York-based plastic surgeon. “It’s not so much that it’s overdone, it’s just not individualized. For surgeons, it’s almost [more] important to decide what not to do than what to do. And that comes with experience.”

In an exclusive statement sent to People magazine, Zellweger dismissed suggestions she’d had work done as “silly” and attributed her highly alert appearance to being in love and enjoying a healthier lifestyle. “I’m glad folks think I look different!” she wrote. “I’m living a different, happy, more fulfilling life, and I’m thrilled that perhaps it shows.”

There is an art to looking “well-rested,” and top surgeons proceed with caution. Dr. Timothy Marten, a San Francisco-based plastic surgeon, notes that “certain areas of the face — in particular the eyes and lips — are known as loci of identity.” In other words, mess too heavily with these parts, and you just might wind up unrecognizable.

According to Marten, traditional eyelid surgery involves removing tissue that “can change the look of the eyes.” With lips, “there’s a tendency with famous faces to overfill the upper lip, and it looks unnatural” — when it should be the other way around.

Here’s a look at Zellweger and other stars remarkably transformed over the years.

Renée Zellweger

Renée Zellweger in 2011 and 2014.Photo: From left: Mike Coppola/Getty Images, Jon Kopaloff/FilmMagic

“She’s a beautiful and talented woman who may or may not have had a facelift,” says Dr. Timothy Marten. “She had a very full upper and lower eyelid and part of the reason she looks different is her eyelids no longer have that full, girlish look we all loved about her. It’s also possible something was done to her lips.” Her face has perhaps lost some of its softness, he noted. “She may have either lost weight or had facial liposuction or radio frequency or ultrasound,” he says, referring to skin-shrinking techniques that can result in the loss of facial fat.

Tatum O’Neal

Tatum O’Neal in 2009 and 2014.Photo: From left: Duffy-Marie Arnoult/, Gregg DeGuire/WireImage

The youngest person ever to win a competitive Academy Award is now 50 and likely fighting the hands of time with injections, not surgery. “It’s all about fat transfer or filler,” says New York-based Dr. David Rosenberg, adding that the substances dissolve so the pillowy effect will wear off.

Kenny Rogers

Kenny Rogers in 2000 and 2014.Photo: Right: Rick Diamond/Getty Images

The singer-songwriter and actor is a wide-eyed and bushy-tailed 76. “It looks like he had his eyes done and possibly a brow lift,” says Dr. David Hidalgo. “It has totally changed his appearance. It doesn’t look like he’s had a facelift because of his neck.” Does he look better? “It’s safe to say that he looks cleaner but he looks different.”

Olivia Newton-John

Olivia Newton-John in 2005 and 2014.Photo: From left: Eric Neitzel/, Bim/Broadimage

We’re hopelessly devoted to the “Grease” star and singer, even if she’s done the lift and fill. “To have a neck like that in your sixties, you’ve had a facelift,” noted Dr. David Rosenberg, adding that she’s probably had some filler or fat transfer and put on a few pounds. “She’s looking beautiful. She looks better than when she was 30 years old.”

Winona Ryder

Winona Ryder in 2005 and 2014.Photo: From left: Steve Granitz/, Bruce Glikas/FilmMagic

Her first major role was as a goth teen in “Beetlejuice,” and while she could no longer pass as a high school student, grad school would not be a stretch. Dr. Rosenberg does not believe the gorgeous 42-year-old actress has had a facelift or her eyes done. “She looks thinner and it doesn’t look surgical. It looks like she has maybe some fillers in her cheeks. You can see the pads under her eyes.”

British woman dies during cosmetic surgery in Thailand

The Guardian, Friday 24 October 2014 12.43 BST


A British woman has died during cosmetic surgery at a clinic in Thailand, authorities in the country have said.

The 24-year-old was said to have been undergoing a procedure by an allegedly uncertified surgeon in Bangkok before her death.

She repoPolice close the street after a British woman was found dead at a beauty clinic in Bangkok, Thailandrtedly died during a corrective procedure after undergoing surgery at the same clinic in the Thai capital weeks earlier.

Boonruang Triruangworawat, an official at the Health Service Support department, said attempts had been made to revive the woman, who stopped breathing after being given an anaesthetic last night.

Police said the doctor who carried out the operations, named as Sompob Sansiri, was later arrested. The clinic has been shut for 60 days while investigations are carried out.

A spokesman for the Foreign Office said: “We were informed of the death of a British national in Thailand on 23 October. We stand ready to provide consular assistance.”

Consultant plastic surgeon Michael Cadier, president of the British Association of Aesthetic Plastic Surgeons, said: “Details are still emerging, but it’s important that the public remember the serious risks involved in any surgery, which are increased by travel abroad.

“This tragic case highlights how, if lured by the prospect of what is essentially ‘cheap surgery’, patients can be left vulnerable.

“Standards for healthcare may vary, and patients frequently undergo ‘consultations’ with company representatives who have no medical background, and are therefore not being given the appropriate knowledge in order to give informed consent.

“In some cases, patients are even being treated by a person without proper surgical credentials – if any at all – which breaches all the fundamental guidelines for safe practice in cosmetic surgery in the UK.”

Brazil surpasses U.S. in number of plastic surgeries

Janet Timal, 47 (right), stands with her niece Thairine, 21. Janet has had a tummy tuck and breast augmentation and helped her niece pay for liposuction. "The ideal is to be able to put something on, to sit down and not have your belly jumping out. Here in Brazil it gets hot, and the less clothes, the better," says Janet.

Jimmy Chalk for NPR

October 07, 201412:11 PM ET
Lourdes Garcia-Navarro Janet Timal, 47 (right), stands with her niece Thairine, 21. Janet has had a tummy tuck and breast augmentation and helped her niece pay for liposuction. “The ideal is to be able to put something on, to sit down and not have your belly jumping out. Here in Brazil it gets hot, and the less clothes, the better,” says Janet.

Janet and Jaqueline Timal are 40-something-year-old sisters, and they have what they call a plastic surgery fund. “I’m always saving money. When I see I’ve gathered up enough money for another surgery I do it,” Jaqueline says. She has had breast implants put in and also a tummy tuck. She’s visiting the plastic surgeon’s office again to do a famed Brazilian butt lift, which is the same as a breast lift, but on your backside. Janet has had a tummy tuck; she’s now doing her breasts, too. Between them, they will have had five surgeries.

Janet and Jaqueline aren’t rich — far from it. One works at a retirement home; the other owns a small shop. They both say this isn’t about bankrupting themselves for beauty but rather the opposite — Jaqueline says she sees the procedures as an investment. “I think we invest in beauty because this is very important for women here. You can get a better job because here they want a good appearance, a better marriage because men care about the way you look,” she says.

Brazil has just surpassed the U.S. as the place with the most cosmetic surgeries performed in the world, even though it has fewer people and collectively less disposable income than the U.S. Last year, according to the International Society of Aesthetic Plastic Surgery, 1.5 million cosmetic surgeries were carried out in Brazil — 13 percent of all the elective plastic surgeries done all over the world.

One reason is that Brazil simply has more plastic surgeons per capita than the U.S. There’s a health care crisis in Brazil that has led the country to import doctors from Cuba to work in rural and poor areas. Yet there’s a surfeit of plastic surgeons.

The other reason is women’s increasing financial power. In the past 10 years, Brazil has grown economically, and salaries and disposable income have gone up. Women like the Timal sisters have overwhelmingly chosen to use that money on their appearance.

While in the U.S., people may hide that they have had plastic surgery like it’s something shameful, in Brazil they flaunt it. The attitude is that having work done shows you care about yourself — and it’s a status symbol.

But even though people have more money and greater access to credit, many of the poor wouldn’t be able to afford to pay for all of their cosmetic procedures unless they got a helping hand.

The Ivo Pitanguy Institute in Rio de Janeiro is named after the famous Brazilian plastic surgeon who is renowned for saying, “The poor have the right to be beautiful too.”

Here the ethos is beauty shouldn’t just be a privilege of those who can afford it.

The institute’s lobby is packed as attendants call out the names of women — and a few men — who are waiting to be evaluated for cosmetic surgeries. This is a charity and teaching hospital, and the surgeries given are either free of charge or heavily subsidized.

The hospital offers all the usual fare: breast implants, breast lifts, Botox, nose jobs, face lifts and, of course, the ever-popular butt implant.
This is where the Timal sisters are having their surgeries. The price for Jaqueline’s butt lift? It’s 3,800 reals, about $1,600. At a private hospital it could run over three times that.

Francesco Mazzarone, who now heads the institute, explains why it’s important to provide cosmetic surgeries to the disadvantaged. “This is about equality, which is the philosophy Pitanguy created. Equal rights to everyone. The patients come here to get back something they lost in time. We give to them the right to dream,” he says. “What we do here is altruism.”

And the women NPR spoke with are grateful, but they also acknowledge that there is a lot of pressure in Brazil to conform to a physical ideal.

Jaqueline Timal says her 21-year-old daughter has already had liposuction. “I told her she should wait, but to be very beautiful, we push ourselves — and also society pushes us. I think she is too young for that, but as it was her great desire, I supported [her] so she can be happy,” she says.

Some in Brazil, though, balk at the idea that happiness can be achieved at the end of a scalpel.

Being a feminist is a lonely business in Brazil, says Karen Polaz, a blogger and women’s rights activist. She says despite the fact that Brazil has a female president, it’s still a very sexist country. She says beauty as a right sounds good in principle; what that means in practice is that a very narrow view of what is beautiful is being pushed onto people here. “Before accepting the idea that everyone has the right to be beautiful, we have to understand the image of beauty that is being sold, because this is an industry, an extremely lucrative industry. They transform women into consumers,” she says.

And in Brazil, that transformation has a racial component.

Brazil imported more slaves, some 4 million, than any other country. Today, it is a primarily a mixed-race country, but you wouldn’t know that by looking on TV and in magazines here, which rarely feature people of color. “ If you look at the traditional body type of a Brazilian, you would see a woman with dark skin, curly hair, small breasts and a larger bottom, a body that is very different from the body marketed as desirable. – says Marcelo Silva Ramos, an anthropologist and social scientist.

He says what is sold as beautiful here is someone like Brazilian model Gisele Bundchen: a woman who is tall, thin, blond with straight hair, bigger breasts and fewer curves. That has meant people who don’t look the right way — and by this he means “the white way” — are often excluded, he says.

“In our culture, the view is women who look acceptable get money, social mobility, power,” he says.

Take for example the popular Miss Bumbum contest, which annually crowns Brazil’s best backside. All of the contestants this year are lighter skinned.

Claudia Alende, the 22-year-old front-runner of this year’s competition, looks like American actress Megan Fox, right down to the blue contact lenses she wears over her natural brown eyes. She says she is competing for a simple reason.”The contest is famous around the world, and I want to be recognized around the world and become famous, too,” she says, laughing. She says the contest is a way for her to become a TV presenter or an actress. The rules of the contest allow for plastic surgery anywhere but on the backside. She openly admits she’s had work done. “It was [because] everyone was doing [it] so I did [it],” she says.

Previous Miss Bumbum contestants have indeed gone on to arguably bigger and better things. One became a TV presenter; others have become actors and professional dancers on TV. But they are among the few.

Maria da Gloria de Sousa is 46 but looks 30. Maria da Gloria de Sousa, 46, has had six surgeries at the Pitanguy Institute. She’s unemployed but has had six surgeries at the Pitanguy Institute and speaks about her procedures with characteristic Brazilian humor and openness.”First off, I do this for me. These kind of things you need to do for yourself. And second, there’s nothing better than getting a compliment, right? That you’re good, that you’re sexy, it’s really good. I like it.”

"Plastic surgery starts to become an addiction. You're born perfect, but then you have children and you know what having children does. Then suddenly comes the rebirth: plastic surgery. You can be beautiful, even more beautiful than you were before." — Maria da Gloria de Sousa, 46.

Jimmy Chalk for NPR

“Plastic surgery starts to become an addiction. You’re born perfect, but then you have children and you know what having children does. Then suddenly comes the rebirth: plastic surgery. You can be beautiful, even more beautiful than you were before.” — Maria da Gloria de Sousa, 46.

 “I’m almost an android! I had done my breasts three times. I didn’t stop there. I did a tummy tuck and then a lipo, and, lastly, I did my bottom,” she says. She says she has spent the equivalent of the cost of three cars on her operations. “I’m much happier, there is no doubt about it. My bottom will never sag, my breasts will never sag. They will always be there, hard. It is very good to look at the mirror and feel fine,” she says.
When I ask her if it was all worth it, she tells me she has a 21-year-old lover. “Things have gotten a lot better,” she quips. She waves goodbye and, smiling, sashays down the beach — and nothing jiggles.

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