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An otherwise attractive woman, Catherine found that wearing mascara made the drooping lid appear almost normal. But despite countless hours and dollars spent at makeup counters, she was never able to find a formula that concealed the bags and still looked natural.
One month before her 50th birthday, Catherine decided it was now or never. She found a reputable plastic surgeon with whom she felt comfortable and, using her credit card, charged a $2,800 blepharoplasty - the procedure used to remove excess skin and fat from around the eyes.
After the surgery, which lasted about two hours, Catherine admits she was uncomfortable. Besides feeling the usual after-effects of anesthesia, she says her eyelids "felt tight," and the area around her eyes was bruised and swollen. For about a month, her eyes would tear excessively when she was in the sun. But one year later she adamantly states that it was absolutely the best thing she ever did for herself. "I look 10 years younger and I feel it, too," she says. "It was well worth it."
More and more baby boomers, like Catherine, are turning to surgeons to undo the effects of Father Time. According to the American Society of Plastic and Reconstructive Surgeons (ASPRS), 40 percent of those who had cosmetic surgery in the United States in1994 were between the ages of 35 and 50.
Why are baby boomers, more than previous generations, challenging the age-old notion of growing old gracefully? Gregory L. Borah, MD, professor and chief of plastic surgery at UMDNJ-Robert Wood Johnson Medical School in New Brunswick, says one reason is that boomers - known as the "me generation" - take good care of themselves and are proud of the way they look. "They notice deepening crow's feet and new wrinkles," he explains. "And since they're less inhibited than most of their elders, they don't hesitate to do something about it."
Added to that is the fact that they're well informed. Borah, who is also director of the Skin Laser Center at Robert Wood Johnson University Hospital says: "In this era of instant communication, rare is the baby-boomer-age patient who doesn't know a great deal about cosmetic surgical procedures and what each one entails."
Not long ago, esthetic surgery was the exclusive domain of the rich and famous. In recent years, however, advancing techniques have made it more affordable. Of the nearly 400,000 people in the United States who had cosmetic surgery in 1994, 65 percent had household incomes under $50,000. It's also less thought of as fooling with Mother Nature than it once was. An article in the July 6, 1996 New York Times Magazine states that the number of people who say they approve of cosmetic surgery, for themselves or others, has increased 50 percent in the last decade.
It's no longer uncommon for men to have cosmetic surgery either, Borah says, especially 40- to 50-year-old executives and professionals. "They're up against younger men who are on the rise, and getting ahead in business is more or less synonymous with looking good," he notes. "Right or wrong, your image impacts others' perceptions of you."
Research bears out Borah's observation. In a study on attractiveness and perceived intelligence, fifth grade teachers were asked to compare hypothetical academic records that were identical except for the attached photos: Some depicted attractive students, and others their unattractive counterparts. With few exceptions, the instructors said the attractive children were more intelligent, more likely to get advanced degrees and probably had parents who were concerned with their youngsters' academic achievement. Their perceptions of the unattractive students were far less flattering. The study was cited in "Nonverbal Communication" (Brown and Benchmark, 1993).
These attitudes, it's been found, are formed at a very young age. Another study, cited in the same book, had nursery-school children identify those in the class they liked best. An overwhelming majority chose the prettiest or most handsome. When the same kids were then asked to describe their unattractive classmates, most used adjectives like "mean,"dirty" and "stupid" - qualities investigators determined were in most cases untrue.
Since the beginning of time, beauty - or lack of it - has been deemed important. So much so that in ancient Persia "no man with a crooked or deformed nose could sit on the throne." So it's not surprising that the first written account of reconstructive surgery, the precursor to cosmetic surgery, dates back to 3000 B.C., when the treatment for a fractured nose was recorded in Egyptian hieroglyphics. In India, descriptions of nose reconstruction and ear lobe repairs - probably of pierced lobes that had split from the weight of heavy earrings - are thought to have been written about 600 B.C.
Cosmetic surgery, however, is a relatively modern phenomenon. It wasn't until the late 1880s that doctors refashioned a nose for purely esthetic reasons. Physician John Roe wrote in his medical records in 1887: " the nose will stand out and 'make its sign' in spite of all precautions. It utterly refuses to be ignored and we are, therefore, compelled to give it our attention."
Only a few years earlier, in 1881, an otoplasty - the procedure to correct protruding ears - was performed at Manhattan Eye and Ear Hospital. Four years later, the first breast augmentation was tried in Heidelberg, using a tumor from the patient's back as the implant. The first tummy was tucked in 1899, and soon after the first eyelids and faces were lifted.
These early procedures were not without their problems. During the first two decades of the 20th century, plastic surgeons injected paraffin into patients' faces and then sculpted theirfeatures as if they were wax figures. The effect was often striking, but people suddenly began dropping dead from wax clots that had migrated to their arteries.
Face lifts of the early 1900s were rather simple, but the results left much to be desired. An S- or crescent-shaped incision was made at the hairline or behind the ears and the opposite sides of the opening were stitched together. There was only the slimmest chance of deadly side effects, but because the skin is pliable, the youthful look was often fleeting. Legend has it that in her later years Marlene Dietrich, tired of having short-lived lifts, secured facial sags by sticking hat pins into her scalp beneath her wig.
Things have come a long way since then. Today's surgical procedures are much more sophisticated and there is a full array of options for achieving a desired effect. What do people choose from the make-over menu?
Borah says in his practice teens most often want rhinoplasties, better known as nose jobs. For those in their 20s and early 30s liposuction is the first choice. And the youth-clutching baby boomers most often ask for eyelid surgery and face lifts, followed closely by skin resurfacing - either by chemical peel or laser -and liposuction, with twice as many woman as men wishing to instantly do away with excess fat. Males most often want hair restoration and liposuction, Borah says. "They particularly want to liposuction away turkey neck."
Marek Dobke, MD, program director and chief of reconstructive and plastic surgery at UMDNJ-New Jersey Medical School, says he believes both sexes are seeking the same result when they opt to change their countenance, but each perceives beauty differently. "The women say they want to look younger," he explains, "but the men tell me they want to look refreshed or rested - good for their age."
He believes technological advances in cosmetic surgery are partly responsible for its rise among the baby boomers. For example, Dobke says resurfacing the skin is now much easier and less painful because of lasers: "A laser enables a physician to be very precise. The actual procedure is quicker than a chemical peel, and since there is less damage to the tissue, the healing time is reduced. And lasers are becoming more common so the cost is going down."
Another medical instrument, the endoscope, commonly used in diagnostic procedures is now being used by plastic surgeons. This narrow, tubular probe with a camera on the end is used mostly to do brow lifts.
Instead of making an incision along the hairline from ear to ear and peeling the skin back to work on underlying layers, Dobke explains, the endoscope is inserted into a small scalp incision. With a scalpel that is inserted into a second small incision, the surgeon moves underlying tissue to correct creases in the forehead and create a smoother look. "The scars are much smaller and there's less trauma and swelling," he notes.
Dobke says among the newer procedures, liposculpturing - the removal of fat from one area of the body and inserting it into another - has become popular. "We now take fat from under the epidermis of a thigh, for example, and inject it into the face to plump up creases, furrows, sunken facial skin and scars," he explains. "It's more natural looking than collagen and it's safer. A patient won't have an adverse reaction to his own fat."
He adds that some of the fat cells may not survive the transplant, however, and more may need to be added over time. It also may be unevenly reabsorbed by the body, leaving lumps.
A toxin known as botulin - the same one that causes botulism in canned foods - has taken on a positive role in cosmetic surgery. It is used to correct creases between the eyebrows. When injected into the frown muscle, known as the corrugator, it eliminates the crease by paralyzing the muscle. "We use only small doses in very low concentrations, so it's relatively safe," Dobke says, "However, it's expensive and the effects may last only six months to a year."
Baby boomers haven't overlooked their smiles in their quest to look youthful. About 20 percent of those now wearing braces in this country are adults, according to Martin Giniger, DMD, PhD, director of the Division of Diagnostic Services at UMDNJ-New Jersey Dental School. The dentist says the advent of clear braces and the ability to install a particular type behind the teeth has made the process more adult-friendly.
Teens through boomers who want a sparkling smile are having their teeth bleached. This method, which has become very popular in the last two or three years, is an inexpensive, painless alternative to capping, bonding or having veneers applied to whiten teeth. A patient simply fills the wells of a custom-made mouth guard - similar to those worn by athletes - with a solution of 10 percent carbamide peroxide and wears it two hours a day for 14 consecutive days.
"It's not harmful to the enamel surface of the teeth and it's completely painless," Giniger says. It costs about $150 per arch or $300 for the entire mouth. The only drawback, he adds, is that it lasts only 16 months to two years, "but most patients are very satisfied with the results."
Giniger warns against using over-the-counter bleaching systems. Because they are considered a cosmetic, they are not regulated by the Food and Drug Administration (FDA). "Their safety cannot be ensured," he says. "Some of them contain very caustic solutions that can harm the teeth and the gums."
A not-ready-for-prime-time procedure to whiten teeth is the laser removal of stain."It hasn't been approved by the FDA yet, and it's so new that we don't know how safe it is. But it looks promising," Giniger says. "It's painless and will mean no home treatment; a patient will leave the chair with shiny white teeth."
In short, baby boomers are taking advantage of all the methods available to resurface, reshape and resize every part of the human body. However, Borah and Dobke both caution that there are risks in having any of the procedures performed. "It's real surgery and shouldn't be taken lightly," Borah notes. "Along with possible adverse effects from anesthesia, there is also the possibility of infection, bleeding and blood clots. Generally it's safe, but a person should certainly discuss the risks and benefits with his or her doctor before making a decision."
Both say finding a board certified plastic surgeon one feels comfortable with is paramount to a satisfactory result. "Any MD can perform plastic surgery, so it's essential to find out about credentials," Dobke advises. "Ask for references and talk to others on whom she's performed surgery. It could make a world of difference."
As for the future of cosmetic surgery, Borah says it's impossible to predict what revolutionary changes may come along. "Someday we may be able to accomplish some of these effects without surgery," he says. "We might be prescribing fat-burning pills and anti-aging creams or applying new layers of artificial skin right in the office. And if today's kids maintain a healthy lifestyle and guard against the sun, we may not be seeing many of them at all."
FACE
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This chart offers a general overview of some cosmetic surgical procedures. Most are done on an outpatient basis using local anesthesia. Some do require hospitalization and/or general anesthesia. There is a risk of infection and scarring in all procedures; patients will also experience discomfort, swelling and bruising. Circumstances and experiences of every individual will be unique. |
CHEMICAL PEEL |
COLLAGEN/FAT INJECTIONS |
Cost: $700-$1,400 Procedure: Restores wrinkled, blemished, unevenly pigmented skin using phenol or trichloroacetic acid (TCA) to peel away the top layers of skin. Works best on fair, thin skin with superficial wrinkles. Length: 1-2 hours for full face. Possible Side Effects: Acute sensitivity to sun, permanent lightening of skin, inability to tan, flare-up of skin allergies, permanent abnormal color change. Recovery: New skin, 7-21 days; normal activities, 2-4 weeks; fully healed and fading of redness, 3-6 months. Duration of Results: Phenol, permanent. TCA, temporary. |
Cost: $300-$700 Procedure: Plumps up creased, sunken facial skin and scars; adds fullness to lips. Works best on thin, fair, dry skin. Length: 15 minutes to 1 hour per session. Possible Side Effects: Collagen: Allergic reactions including rash, hives, swelling or flu-like symptoms. May be associated with connective tissue or autoimmune diseases. Both: Contour irregularities, excess fullness. Duration of Results: A few months to one year. |
DERMABRASION |
EYELID SURGERY
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Cost: $1,500 Procedure: Mechanical scraping of top layer of skin using a high-speed rotary wheel to soften surface irregularities, wrinkles and scars. Length: Up to 1 1/2 hours; may require multiple sessions. Possible Side Effects: Lightening of skin, acute sensitivity to sun,permanent abnormal color changes. Recovery: Back to work, 2 weeks; strenuous activity, 4-6 weeks; fading of redness, 3 months; return of pigmentation, 6-12 months. Duration of Results: Permanent. |
Cost: $1,500-$2,800 Procedure: Corrects drooping upper lids and bags beneath eyes by removing excess fat and skin. Length: 1-3 hours. Possible Side Effects: Temporary burning and dryness of eyes, light sensitivity, double vision, difficulty in closing eyes (rarely permanent). Recovery: Reading, 2-3 days; back to work, 7-10 days; contact lenses, at least 2 weeks; strenuous exercise and alcohol, 3 weeks; bruising and swelling gone in several weeks. Duration of Results: Several years to permanent. |
FACELIFT
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FOREHEAD LIFT |
Cost: $4,300 Procedure: Correct sagging facial skin and loose neck skin by removing excess fat, tightening muscles and redraping skin. Usually done on people over 40. Length: Several hours. Possible Side Effects: Injury to nerves that control facial muscles, excess scarring, asymmetry or change in hairline. Men will need to shave behind ears, where beard-growing skin is repositioned. Recovery: Back to work, 10-14 days; strenuous activity, 2 weeks; bruising, 2-3 weeks; limited exposure to the sun, several weeks. Duration of Results: 5-10 years. |
Cost: $2,100 Procedure: Minimizes forehead creases, drooping eyebrows, hooding over eyes and furrowed forehead by removing excess tissue and redraping skin. Length: 1-2 hours. Possible Side Effects: Temporary headaches, numbness, itching and hair loss. Permanent change in hairline, injury to facial nerve causing loss of motion, muscle weakness or asymmetrical look. Recovery: Back to work, 7-10 days; strenuous activity, several weeks; limited exposure to the sun, several months. Duration of Results: 5-10 years. |
HAIR
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LASER SKIN
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Cost: Because of variations in procedures, fees are not available. Procedure: Fills in bald areas with patients' own hair using scalp reduction, tissue expansion, strip grafts or clusters of punch grafts. Works best on men with male-pattern baldness after hair loss has stopped. Length: 1-3 hours. Some techniques require multiple sessions for at least 18 months. Possible Side Effects: Achy, tight scalp; unnatural look; failure to "take"; loss of scalp tissue and/or transplanted hair. Recovery: Back to work, 2-5 days; strenuous exercise, 10 days to 3 weeks. Duration of Results: Permanent. |
Cost: $1,500-$3,000 Procedure: Removal of fine wrinkles and reduction of deep wrinkles, acne scars, skin blemishes using a laser. Particularly good for area around eyes and mouth. Length: 30 minutes to 1 hour. Possible Side Effects: Lightening of skin; abnormal color changes in darker individuals. Recovery: Dressings, 7-10 days; redness, 10-12 weeks. Duration of Results: Permanent. |
NOSE SURGERY
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This information, provided by the American Society of Plastic and Reconstructive Surgeons, is updated every other year. New data will be available this spring. |
Cost: $2,800-$3,100 Procedure: Reshapes nose by reducing or increasing size; removing hump; changing shape of the tip, the angle between nose and upper lip, or the bridge; narrowing span of nostrils. Length: 1-2 hours. Possible Side Effects: Small burst blood vessels resulting in tiny, permanent red spots. Recovery: Back to work, Duration of Results: Permanent. |
