July 13, 2016
April 19, 2016
When it comes to cosmetic surgery, a blepharoplasty or "eye lift" is one of the simplest, safest, and most effective procedures you could undergo.
"You really cannot get more bang for your buck," says Michael Olding, MD, chief of plastic and reconstructive surgery at George WashingtonUniversity. "I have people come in all the time who say they want a face lift, and they can't believe it when I tell them they only need an eye lift."
Olding points out that, when you're speaking with someone, you usually look at their eyes—not their nose, mouth, or other areas often targeted for cosmetic surgery. "If your upper eyelids look saggy, that can make you look tired, old, and not engaging," he says. "So getting rid of that redundant skin on the upper lids can make a dramatic difference." (Lose up to 25 pounds in 2 months—and look more radiant than ever—with the new Younger In 8 Weeks plan!)
Here, he explains everything you need to know about the procedure—including the cost, specifics of the surgery, and recovery times.
There are actually several types of eye lifts.
When you hear the term "eye lift," that usually refers to a surgery of the upper eyelid. "It involves removing excess skin, and maybe a little muscle or fat," Olding says.
The second, less-common type of eye lift involves the lower lid or the area below your eye. "If you have big bags under your eyes, they can be easily removed without a visible incision by going inside between the eyeball and eye lid and moving or manipulating fat," Olding explains. He adds: "We used to just take out every bit of that fat. But then people—as they got older—would have a hollow look below their eyes. So now it's more about redistributing that fat." (Lash lifts are now a thing, too. Should you try them?)
All of these are outpatient procedures.
For an upper eyelid lift, Olding says the surgery involves local anesthetic either with or without some local sedation—but never with general anesthesia.
Your doctor will mark the portion of your eyelid she intends to remove. And then, using a scalpel or other surgical cutting devices, she'll snip away that skin and close the incision with stitches. Thanks to the natural folds of your eyelid, any scarring is basically hidden, Olding says. If you're having under-eye bags removed, there may not even involve a visible incision. "But if you have surgery performed on your lower lids, that's a more complex procedure and requires sedation," he adds.
All these procedures may also include lasering your lids to improve the quality of the scar, and to remove signs of sun damage and aging, Olding says. For under-eye bags, your doctor may also inject fillers to smooth the areas, according to the American Society for Aesthetic Plastic Surgery.
Recovery is (usually) quick.
For an upper eyelid lift, the bruising and swelling tend to be minimal. "Most people could drive themselves home after the surgery, though we never recommend that," Olding says.
Some people experience more swelling and bruising than others, but that typically goes down after a couple days, he says. "The sutures come out after 3 to 5 days, and by day six you can apply makeup and not tell anything was done."
During that first 24 hours, you'll likely have to ice your eyes regularly to keep the swelling down. You may also have to apply drops or topicallubricants for a few days, or take antibiotics to prevent infection.
Having skin removed from the lower lid tends to involve longer recovery times. "Gravity is working to pull skin down away from the eye, so that makes it more complex," Olding says.
But if you're having bags removed, you could be "back to normal" the day after surgery. "Since there may be no incision at all, it's really all about how much you bruise," Olding adds. (Not ready for surgery? Try these makeup tips to lift droopy eyes.)There could be complications.
The major risks of any of these surgeries are excessive bleeding or bruising, and "asymmetry," Olding says. "A doctor could take out too much skin, or not enough." While removing too little simply requires a follow-up procedure, taking out too much can leave a patient without adequate skin to cover her eye when blinking or sleeping. "But that's extremely uncommon," Olding says. He's quick to point out that eye lifts are never to blame for the "deer in headlights" look mocked in tabloids and celebrity mags. "That's from an improperly done forehead lift, so no need to worry about that here."
"Aging and sun damage combine to make the skin of your eyelid less elastic," Olding says. For some people, that causes the skin of their lids to sag so much that it begins to obstruct their vision.
If your doctor suspects your vision is compromised, he may suggest a "visual field examination," Olding says. "You sit in front of screen, and press a button when you see lights appear." You'll repeat this once with your eyelids "taped up," and again without assistance. Depending on your results, you may need an eye lift in order to see properly.
Insurance may cover it.
If your vision is obstructed, some insurers will pick up the tab for a lid lift. We know what you're thinking: Bring on the test! But Olding says it's difficult to "game" the visual field exam. "The test is done in a way that makes it very hard to cheat," he says. (Here are 6 more surprising things insurance may cover.)
Even if you can get insurance to foot the bill, Olding says you may have to pay extra if you want your doctor to go beyond what's necessary for proper vision. "A lift for aesthetic purposes may involve removing more skin in different places," he says.
If you're paying for the whole operation out of pocket, expect to pony up between $1,500 and $5,000, he says.The surgery won't last forever.
After you've had an eye lift, the passage of time and the sun's rays will continue to damage your eyelids' looks and the skin's elasticity, Olding says. (These simple face exercises can help fight wrinkles.) You likely wouldn't need a duplicate procedure for many years, and the vast majority of patients never need a repeat eye lift. But if you undergo the surgery during your 50s or 60s, understand that you may not enjoy the same level of eyelid rejuvenation for your lifetime.
March 9, 2016
The decision to undergo any sort of cosmetic procedure, especially a facelift, is very personal and not to be taken lightly. You've got to make sure you're in the right hands and then consider the financial commitment, your expectations, any potential pain or discomfort and of course recovery/downtime.
If you do decide to green-light a cosmetic procedure, it's important to note that most do have a shelf life. The good news? You can influence what that shelf life is!
Your age, medical history and genes all play important roles in determining how well a procedure will go and how long the results will last, but certain lifestyle factors can also influence the outcome. When it comes to facelifts, Michael Olding MD, Chief, Division of Plastic Surgery at George Washington University and member of ASAPS says, "The longevity of the facelift is determined not only by the expertise of the surgeon, but also by the quality of the skin (which is determined by the genetic makeup of the individual and the exposure to damaging effects of ultraviolet light -both sun and tanning beds.) If the skin at the time of the procedure is sun-damaged and inelastic, the result will not last as long as say, someone who has little sun damage."
Cosmetic surgery, laser skin resurfacing and other procedures have the potential to take years off of your face. Here are 5 solutions to help you maintain your new, youthful look for as long as possible:
1. Sun protection. Adequate sun protection is essential to maintain post-procedure results. Though it's a major part of any anti-aging regimen, it's especially important now, as any scarring could become sun-damaged which could lead to a more noticeable scar in the future. Dr. Olding explains, "Adequate sunscreen is more important than any other cream or ointment a patient might read, hear about, or purchase." Choose a broad-spectrum sunscreen with an SPF of 30 or higher and consider using makeup with added sun protection in it as well.
2. Maintain a consistent weight. The process of aging takes a toll on the elasticity of our skin anyway, but when skin is stretched out and constricted due to weight gain and weight loss, it can exacerbate the issue, making it even more lax. Especially after undergoing any procedure you'll want to keep your weight from fluctuating too greatly. Dr. Olding cautions against any sort of weight gain/loss cycle saying, "You do not want to over expand your skin envelope and then deflate it. The same thing happens to your breasts during pregnancy, and look what happens to them after you return to normal weight. They fall. So does your face after gaining and losing a lot of weight."
3. If you smoke, quit. Health detriments aside, smoking wreaks havoc on your skin. This is due to a decrease in circulation, oxygen levels and healing, an increase in free radicals which impair collagen production, and the process of repeated puckering from inhaling which results in wrinkles around the mouth.
4. Follow a healthy lifestyle. Regular exercise, eating a balanced, nutritious diet and staying hydrated will go a long way toward maintaining your new-and-improved look. Give your body what it needs to heal and help itself maintain its condition.
5. Use professional skincare products. Medical-grade skincare products contain higher concentrations of active ingredients than over-the-counter products and are clinically proven to give results. Your doctor can help personalize the best skincare regimen for you.
Surgery, procedures and anti-aging treatments can help turn back time, but not stop it. Good skin quality before surgery will help you achieve the best results, but taking care of your skin and yourself post-procedure will help you maintain those results for as long as possible.
March 9, 2016
The Authoritative Source for Current U.S. Statistics on Cosmetic Surgery.
Expanded data for 2015: Multi-year comparisons, 38 Cosmetic Procedures.
The American Society for Aesthetic Plastic Surgery
March 7, 2016
For the first time on record, Americans spent more than 13.5 billion dollars on combined (surgical and nonsurgical) aesthetic procedures in a single calendar year, according to the American Society for Aesthetic Plastic Surgery (ASAPS). The total reflects a 1.5-billion-dollar increase from 2014. Surgical procedures accounted for 58% of the total expenditures, surpassing the 8-billion-dollar mark for the first time ever, and nonsurgical procedures accounted for 42% of the total expenditures, surpassing the 5-billion-dollar mark for the first time ever.
“Our industry’s growth is considerable, but not at all surprising,” states James C. Grotting, MD, President of ASAPS. “It reflects a healthy and robust economy wherein many people can afford to, and want to invest in themselves. As editor Joel Stein aptly pointed out last year in TIME Magazine’s article, Nip. Tuck. Or Else., more people now perceive aesthetic enhancements and procedures as essential. I personally believe the motivating factors for that are varied, but remaining competitive in the workforce is certainly a common factor. Youth is a commodity, and people are investing in themselves to maintain a younger, healthier appearance,” Grotting explains.
ASAPS’ data also reflects emerging and changing trends from previous years, including:
- Breast lifts replacing rhinoplasty as the 5th most popular procedure for the year, (with liposuction,breast augmentation, tummy tuck and eyelid surgery in the 1st – 4th places respectively)
- Fat transfer to the face, (a new category for ASAPS this year) instantly landed in the top 10 surgical procedures in the number 9 slot.
- Nonsurgical skin tightening jumped from 9th to 7th most popular procedure in the nonsurgical category, while also securing the 5th spot for most popular procedures among men, replacingmicrodermabrasion in the top 5 for males.
- Labiaplasty, still considered a ‘new’ procedure, saw another increase in 2015, (16%) as did buttock augmentation, with a 21% increase in implants and fat transfer combined, and a 32% increase in buttock lifts.
- The two most popular injectables year-over-year, (botulinum toxin and hyaluronic acid) both saw continued growth, with botulinum toxin, (BOTOX, Dysport and Xeomin) surpassing 4 million procedures performed and hyaluronic acid, (Juvederm Ultra, Ultra Plus, Voluma, Perlane, Restylane, Belotero) surpassing the 2 million procedures performed mark for the first time this year as well.
Daniel C. Mills, MD, President-Elect states, “Ever-popular procedures, including liposuction and breast augmentation, also saw growth this year as the first and second most popular surgical procedures overall, accounting for nearly 40% percent of the surgical procedures performed, demonstrating that the power and permanence of the knife continues to dominate the plastic surgery marketplace.”
To obtain a full copy of ASAPS’ latest statistics, including a brand new PDF book containing press-ready infographics, please visit http://www.surgery.org/media/statistics.
The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.
About the ASAPS Cosmetic Surgery National Data Bank
ASAPS, working with an independent research firm, compiled the 19-year national data for procedures performed 1997-2015. A paper-based questionnaire was mailed to 30,000 board-certified physicians. An online version of the questionnaire was also available. A total of 844 physicians returned questionnaires, of which 103 were retired or otherwise inactive during 2015.
Final figures have been projected to reflect nationwide statistics. Though the confidence intervals change by procedure, depending on the grouping’s sample size and the response variance, the overall survey portion of this research has a standard error of +/- 3.56% at a 95% level of confidence.
November 19, 2015
Shaving, waxing, tweezing, sugaring. There are almost as many well-worn ways to remove body and facial hair as there are areas that it sprouts on.
And then there are lasers. The American Society of Plastic Surgeonsestimates that more than a million Americans used the procedure in 2014, a 51-percent rise since 2000.
Once forbiddingly high-tech, laser hair removal has been democratized. Laser prices are down, availability in medical offices and salons is ubiquitous, and there’s no shortage of pop culture devoted to the devices: Witness Kim and Khloe Kardashian getting laser hair removal on an episode of Keeping Up With the Kardashians.
Still, this method of hair removal isn’t exactly cheap yet—the average price for treating one area of the body is about $1,700. And if you envision some sort of quick, Star Wars–style ray-gun blast, it’s not that simple: You’ll have to treat most areas multiple times over months for a significant reduction in hair growth.
So how do you choose where—or if—to go under the light?
How It Works
Unlike shaving and waxing, which remove hair already on the skin’s surface, lasers target what lies beneath: the follicle under your dermis. Using selective photothermolysis (SPTL), lasers cause localized damage by heating dark targets (in this case, melanin in the follicles) without burning the rest of the skin.
With a hand piece that looks like a vacuum cleaner’s hose attachment, a technician or physician emits split-second beams of light to preshaved skin. The energy destroys the hair bulb underneath, and a few days or weeks later, the remaining hairs push out, shedding what looks like a bunch of eyelashes, ashes, or, occasionally, a small clump of hair.
How Long It Takes
Sessions vary in length depending on which body part you’re having treated—a little fuzz on your chin might take five minutes to zap, while a thick-skinned man’s back could require 30 minutes or more. No matter where you’re going barer, you’ll likely need six to eight sessions with a professional-level laser to see full results, typically an 80-to-90-percent reduction in hair growth.
The reason for so many visits? Laser beams work best on follicles in the active “anagen” growth phase, and to kill all (or nearly all) in one zone, you have to come back several times.
Humans have anywhere from 50 to more than 300 follicles per square inch of skin. “It’s unpredictable how many you’ll catch in an active state,” says Shobha Tummala, founder of Shobha, a hair-removal chain known for sugaring and waxing that recently started offering laser hair removal at its downtown DC branch. “All kinds of things can affect how many hairs will be hit in a given session—hormones, vitamins.”
Other times, patients are surprised by how quickly they become smoother. “I was shocked that even after only four visits to the laser clinic, I went from having a thick, bushy bikini line to nearly nothing,” says a woman we’ll call Andrea for privacy reasons. “I didn’t even finish up my series, and I’m still happy with the results.”
Patients often choose to undergo the procedure during what the industry calls “laser season”—fall through spring, when letting hair regrow between sessions isn’t as noticeable. That’s because, while you’re allowed to shave between appointments, you can’t wax or tweeze. “The follicles need to be present so you can get at them,” says Lee. “You can’t laser something that isn’t there.”
RELATED: 6 Quick, New Skin-Saving Products to Try
Picking the Right Laser
The type of lasers used to zap follicles varies depending on your skin and your natural hair color. Diode and alexandrite lasers, which emit shorter pulses, are usually good for fair and medium complexions with darker, coarser hair. Olive-to-black-skinned customers are typically treated with the Nd:YAG laser, which has a longer wavelength, meaning beams penetrate deeper into the skin so as not to burn the surface; laser burns were once more of an issue for darker complexions with more melanin. Still, technicians sometimes do use less power to avoid burning darker-skinned clients.
Blonds and redheads can be treated, but the lower level of melanin in their hair means lasers won’t be as effective, and some practices won’t even take on those patients. Gray hair can’t be targeted by lasers due to its lack of melanin, so beware a practice that says it can.
“When someone with fair hair requests laser removal, I steer them towards an alternative treatment such as threading or waxing,” says dermatologist Tina Alster, founding director of the Washington Institute of Dermatologic Laser Surgery, which has offices in downtown DC and Chevy Chase. Dr. Alster’s practice has been using lasers to banish hair since the early ’90s.
Seek out an experienced practitioner, whether that’s a laser technician with board certification in his or her jurisdiction or, to be extra-cautious, a dermatologist, who can better address potential complications such as burns, scarring, or blistering.
If you opt for a laser hair-removal center, look for a practice devoted to that, not hair or nail salons that do it on the side and thus may not have the best lasers or most experienced staff. And look for membership in professional organizations such as the Society for Clinical & Medical Hair Removal and the International Aesthetic & Laser Association.
Where You Can You Get Zapped
Like that trusty Gillette or pot of wax, lasers work on almost any area where hair grows. It’s a particular boon in zones of coarse growth—the bikini line, men’s necks—that are prone to bumps and irritation from shaving.
“We’ve got lots of male clients who like to lighten their facial-hair loads, particularly if they are susceptible to folliculitis”—inflamed or infected hairs—says Alster.
The most common zone to treat? For men, backs and chests; for women, bikini lines and underarms. “I’m quite fair, but it’s weird—my underarm hair was really dark, like a 5 o’clock shadow,” says Heather Klein of Potomac, who had her armpits and bikini line lasered in 2011 and 2012. “The treatment really worked, and now I can wear a sleeveless top.”
Legs, arms, and stomach are also top choices, as are small areas of the face—cheeks, chins, and unibrows. “But you can’t do the under part of your eyebrows,” says Shobha Tummala. “The laser could burn your eye.” That’s also why technicians and anyone getting zapped must wear protective goggles during treatment.
The Long-Term Results
The Food and Drug Administration considers laser hair removal a “hair reduction” treatment because, at any time, previously inactive follicles can begin producing new hairs due to hormonal changes and other factors.
As for active follicles, the more treatments you get, the sparser the regrowth and the weaker the remaining hairs. “Follicles are a lot like weeds,” says Alster. “The more you attack them with a laser, the fewer come back the next time.”
Dr. Eliot Battle, cofounder of Cultura medical spa in Friendship Heights, says that as treatment progresses and hair gets finer and thinner, he might use a different type of laser.
Many patients report that even if they still have a few remaining hairs in the area treated, the thinner, scarcer growth is simple to manage with a razor or occasional wax job. Others go back for a laser session once a year to pick off strays.
The same technological advances that have propelled the in-office laser boom have produced a slew of new at-home devices.
“They can be a great deal—usually $500 to $800 apiece,” says Alster. “They’re not as strong as in-office machines, so you have to do twice as many treatments as you would at a doctor’s office. But people like the idea of lasering in the privacy of their home.”
Top brands include Tria, which uses diode lasers that emit zaps at single wavelengths, similar to salon models. Also available: cheaper intense pulsed light (IPL) hair-reduction devices, such as the ones made by Veet, which put out beams of light at multiple wavelengths, meaning less targeted zaps and slower defuzzing.
RELATED: 3 Recommended At-Home Waxing Options
In 2014, the American Society of Plastic Surgeons estimated that the average laser hair-reduction session cost $289 (which, assuming a six-session round of treatments, adds up to $1,734). But in the Washington area, fees vary widely. Most customers buy a three- or six-time package deal, which yields a slight discount over single sessions. (At Shobha, three-session bikini-line banishing runs $396, a $45 savings over buying individual appointments.) Going to a dermatologist typically costs more than visiting a salon.
“It was expensive to do my bikini line—about $1,500 total,” says a woman we’ll call Alice. “But every time they hit me with those beams, I’d think about how much I’d spent on waxing for the past ten years, and I’d feel like it was worth it.”
Beware Groupon-like deals that seem too good to be true. They often come from inexperienced practitioners or from businesses, such as a nail salon, using cheaper, less effective lasers.
The Pain Factor
How much does laser hair removal hurt? The answer depends on your pain threshold, your hair’s color and texture, and the area treated.
“The rule of thumb is that if your hair is darker and coarser, it’s more painful to get rid of,” says Sue Lee of Capital Laser. “The laser has to expend more energy to target it.” Most people describe the zaps as feeling like pinpricks or a rubber-band snap. The ouch factor increases on delicate areas (the Brazilian zone of the bikini line for those taking it all off) and in regions where hair is denser.
“Having my back lasered wasn’t what I’d call an enjoyable experience,” says a man we’ll call Fred. “It felt a little like a series of stinging bug bites, and the duration was worse than the zaps.” Others report only mild irritation. “Getting lasered was somewhat like being pinched,” says Klein. “I felt it more on my bikini line, but it really wasn’t a big deal.”
Technicians can apply numbing cream before treatment to ease the pain—just don’t apply it yourself prior to an appointment, because it’s possible to have an adverse reaction if you overdo the stuff. Post-treatment ice packs and over-the-counter cortisone cream also help with residual redness and bumps, most of which disappear within 24 hours.
Plus, technology is on your side. Modern lasers are equipped with cooling elements to offset overheating skin—specifically, blasts of cold air before or after laser pulses.“And in the past few years, the lasers have gotten much quicker—we’re talking zaps that last a fraction of a second,” says Fadia Hoyek, executive vice president at the Society of Clinical & Medical Hair Removal, a nonprofit devoted to hair-removal education. “Your brain doesn’t have much time to process what’s happening.”
Before committing to this type of hair removal, go for a consultation to be sure you’re a good candidate and you feel confident in the practitioner. A good one should issue pre-laser precautions. An important caveat: Don’t go for a laser treatment if you’re tanned or sunburned or have used a tanning product in the past four to eight weeks. Lasers function by picking up the difference between skin color and hair color, and darker skin could result in extra energy, leading to redness, burns, or blisters. In rare cases, a burn or scar could cause either hypopigmentation (paler spots) or hyperpigmentation (dark spots).
Serious side effects, however, are uncommon. “There is no evidence that there are any negative long-term adverse effects from laser hair reduction,” says Alster. “We use non-ionizing irradiation, so these lasers are safer than exposing your skin to the sun.”
In a 2000–02 study in the Aesthetic Surgery Journal, a test group of 322 subjects received laser hair treatments with a long-pulse alexandrite laser, and just ten reported complications (hypo- and hyperpigmentation).
“Laser hair removal has been around for a long time,” says Michael Olding, head of the GW Medical Faculty Associates’ Cosmetic Surgery Center. “If there were serious complications, we would know by now.”
October 5, 2015
Known for performing risky, complex operations on children who have profound head and facial deformities, Dr. Craig R. Dufresne was already doing aesthetic plastic surgery when a woman presented her own difficult case. Holding up a 1939 Life magazine depicting her as a ravishing young thing, she announced, “I want to look like that again.”
Could he transform the 85-year-old into the ingénue cover girl of her youth? “I told her I went to medical school, not magic school,” recalls Dufresne, who practices in Chevy Chase and Fairfax.
Few people interested in looking younger are that unrealistic. But under pressure to look “fresher,” countless Washingtonians are pondering makeovers, especially around the holidays, when they can go into hiding for a spell to heal.
So how to choose the right surgeon? Here are nine tips.
Know How You Want to Look
Nearly all area surgeons we spoke to describe their work as “natural” or “conservative.” But make sure you agree about what “natural” looks like. Decide in advance what you want to improve—and what you want left alone. Your doctor may concur that your double chin could benefit from trimming and your jowls from lifting. But if you’re fine with the rest of your face and he proposes cheek implants or suggests transforming your cherished ethnic nose into a cute little button, that’s a red flag. So are office staffers who appear over-plumped or tightly pulled, because the receptionist’s surgical procedures are likely the handiwork of that same surgeon. You want a doctor who shares your aesthetic.
Ask Friends and Family for Referrals
Your sister-in-law had a fabulous Brazilian butt lift and adores her charming doctor. If you, too, crave a bounteous booty, make an appointment for a consultation. But if you want a facelift, find an expert in that procedure. Yes, some surgeons do it all and do it well—one look at their online photo galleries will reveal their repertoires—but different body parts require different skills. (More on that later.)
Referrals from people you trust, especially in your age range, may be the best route to a finding a good physician. Ask friends how long ago they had their work done—techniques can change—and how the recovery progressed.
Patients giving referrals may tend to focus on a doctor’s personality, but charm is an overrated attribute that has little to do with surgical skill, and it may vanish altogether if things go awry. (You might look at online reviews for a sense of how a physician addresses patient complaints.) A doctor who listens to what you want and respects your wishes doesn’t necessarily have to be warm and fuzzy, though that’s certainly a plus.
Find a Surgeon Who Specializes in the Procedure You Seek
Many surgeons begin their careers doing general trauma and reconstructive work, moving into aesthetic plastic surgery as they build a practice or narrow their interests. Some tackle the entire body, from forehead lifts to ankle sculpting; others concentrate on the face and neck, or the torso for breast work and tummy tucks.
When you’ve decided what you want, ask how many of your desired procedures the doctor does in a typical week or month. You shouldn’t be a surgeon’s semiannual nose job or breast augmentation. Nor should your liposuction be performed by, say, a board-certified emergency-medicine specialist seeking a piece of the lucrative aesthetics market.
This aesthetic-procedure site is an information gold mine for consumers, featuring a physician Q&A section as well as patient reviews and photos that tend toward the shockingly frank and detailed. You can post your own questions to thousands of doctors—and often get answers from Washington surgeons you may wish to consult.
Their opinions, sometimes in the dozens, can be reassuringly unanimous, or diverse enough to set you thinking about different routes to a newer you—whether long-term surgical, shorter-term injectable (Botox, Juvéderm), or noninvasive mechanical (Thermage, Ultherapy). Some replies read like boilerplate seemingly posted by physicians to get names in front of doctor-shopping consumers; other answers are long and thoughtful.
The website is so useful that many of Dr. Franklin D. Richards’s potential patients know exactly what they want. “The consultation is mainly to come in to test the comfort level,” says Richards, who is with Cosmetic Surgery Associates in Bethesda and McLean.
Understand Credentials, Especially “Board-Certified”
This may be the most confusing part of your research, but it’s extremely important given the number of medical boards, societies, and academies out there.
Start with the American Board of Medical Specialties. Founded in 1933, it certifies US physicians in at least one of 24 disciplines; the specialties you want to consider for cosmetic work include plastic surgery, otolaryngology, and ophthalmology. The American Board of Plastic Surgery certifies physicians in plastic and reconstructive surgery. For surgery only above the collarbone, the American Board of Otolaryngology certifies ear, nose, and throat doctors in procedures involving the head and neck.
Look for additional certification by the American Board of Facial Plastic and Reconstructive Surgery, which, while not an ABMS board, is highly regarded and is a credential your facial plastic surgeon should have. The American Board of Ophthalmology certifies eye specialists, though also look for training in plastic and reconstructive surgery around the eyes; doctors with such experience are called oculoplastic surgeons.
You can verify any physician’s certification on each board’s website or atabms.org. For icing on the cake, the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery both confer additional credentials. The acronym FACS—for Fellow, American College of Surgeons—is peer-conferred by application; a lack of that credential can be telling.
Dr. Steven P. Davison of Washington’s DAVinci Plastic Surgery says other qualifications include being a hospital’s chief of plastic surgery and being published in medical journals, not in the popular press. He also suggests checking for lawsuits as well as disciplinary and licensing problems. Try theVirginia Board of Health Professions, the Maryland Board of Physicians, and the DC Department of Health.
Consult Multiple Doctors, Sometimes More Than Once
Information is power. After researching the procedure you’re interested in, bring your written questions to as many physicians as possible. Some consultations are free; others cost $75 to $150, with fees often applied to procedures. Take notes or go with a friend for a second set of eyes and ears. If you’re having face work, bring in photos taken 10, 15, or even 25 years ago so the surgeon can see how you’ve aged before explaining how she’ll turn back the clock. It can’t hurt to show pictures of people you consider overdone so the doctor understands what you don’t want.
Ask where the surgery will be performed. For privacy, scheduling flexibility, and perhaps lower costs, a physician’s surgical suite or shared ambulatory surgi-center may work best for you, but ask to see a current certificate from organizations such as the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), which accredits all office-based operating facilities, or the Accreditation Association for Ambulatory Health Care (AAAHC). If the doctor doesn’t have a certificate like this, go elsewhere.
If you prefer an accredited hospital because it has on-site emergency services in case something goes wrong, ask where the doctor has privileges for your procedures. If he has none, run the other way.
Discuss sedation options, pain levels, recovery time, and possible complications. Make sure you know who pays for revisions if post-op tweaking or a major revision is required.
After choosing a surgeon, review consent documents together with him. Most forms contain a paragraph giving the physician broad freedom, and you should know exactly what he’s planning to do. A facelift, for example, isn’t a single procedure but a combination of several, which doctors do differently.
You may feel awkward asking such direct questions, but remember—you’re hiring someone to cut into your flesh. Better to endure a bit of discomfort at the outset than to regret the results.
Be Savvy When Looking at Before-and-After Images
In studying pre- and post-op photos on surgeons’ websites and in office “look books,” concentrate on patients who are your approximate age, ethnicity, and body type to get the best idea of the work you can expect.
Examine each set of photos carefully to see if the lighting, camera distance, posture, hair, and makeup appear uniform in the before and after. A before picture taken in overhead light can show unattractive shadows below the eyes and nose and can emphasize facial hollows. Some doctors may take after pictures in more direct, bright light or use a flash to eliminate dark areas and to obscure imperfections. Unsure how the photos were taken? Some physicians will take a before photo during a consultation; even if they don’t, check out the camera setup while you’re in the office.
There are other tricks to watch for. A pre-op chin pointing down makes the neck look worse; a post-op chin tilted up looks better. Arms hanging straight down make before breasts sag, while pulled-back shoulders separate post-surgery breasts so they look perkier. Though doctors may choose to display only a single before and a single after shot, they generally document their work for peer review with as many as five or six shots of each procedure taken from various angles. Request to see them all.
Consistency in facelift photos is especially important. An unsmiling, neutral before mouth usually turns down at the corners; a slight after smile looks better than actual results might indicate. For the best read on scars, ears shouldn’t be hidden by hair or jewelry.
Ask how long after a facelift the post-op images were made. They can look quite good within a few weeks, during the so-called honeymoon period when after-surgery swelling plumps the tissue and makes skin look smoother and more youthful. Once swelling subsides, loose skin, wrinkles, and neck bands can reappear.
“I take all views at three months because that’s about when you have something close to what they get, but the most ethical photos should be taken a year out,” says Dr. Edwin Williams III, president of the American Academy of Facial Plastic and Reconstructive Surgery.
There’s one unintended variable, says Robin Ntoh, who teaches photography to the staff of DAVinci Plastic Surgery. Women who have had face and neck surgery may appear in before pictures—taken right before surgery—without makeup but will arrive for the after shot carefully made up and coifed because they’re going to work. They’re not asked to scrub their faces and pull back their hair.
Some doctors also use before-and-after videos. J. William Little of FaceliftDC, a surgeon who focuses solely on the face and neck, superimposes moving yellow lines on a series of dissolving photos that highlight exactly what’s been changed. These can be more instructive than the cheery video testimonials and interviews some doctors prefer.
Don’t Be Fooled by Reviews
Reviews are everywhere these days, on sites ranging from Vitals.com,RateMDs.com, and RealSelf.com to Yelp and Angie’s List. Some comments appear soon after surgery, but reviews posted several months to a year later are likelier to reflect true results. Beware a flurry of effusive endorsements that pop up soon after a surgeon has been criticized. It’s possible they’ve been written by the doctor, staff, or reputation managers to bury the negatives and raise overall ratings. If your prospective surgeon has been slammed, ask her to explain. Rival physicians or disgruntled ex-employees have been known to trash doctors. But bad reviews can also describe real mistakes, so listen well to how candidly your prospective surgeon addresses your concerns.
Don’t Be Pressured
After doing all this research, you may conclude you’re not ready for surgery, either physically or emotionally. A good physician may come to the same conclusion. Dr. Michael Olding of DC recalls a recent patient who came in to discuss a possible facelift. After looking at her closely, Olding said: “You really have a nice smile—maybe you should just get your teeth bleached.”
Remember, there are things you’ll know more about than the doctor—namely, how you want to look and what you’re willing to risk.
Annie Groer writes about culture, politics, and design and is at work on a memoir. Her last Washingtonian story was about selling family gravesites.
This article appears in our November 2015 issue of Washingtonian.
September 17, 2015
The latest development in Botox—injecting the scalp with the paralysis-inducing toxin to prevent sweating and to prolong a salon blowout—sounds like the stuff of dermatologic urban legend, or at least a vaguely scary detail from some science-fiction novel about a beauty-obsessed future. “That’s not a thing,” say those who hear about it.
August 13, 2015
Dr. Michael Olding, Cosmetic Plastic Surgeon at The GW Medical Faculty Associates, comments on the recent Waist Trainer trend.
July 28, 2015
Flash sale sites like Groupon are great for things like massages, especially if you are already familiar with the person offering the service, but for cosmetic procedures? “Very risky behavior!” says plastic surgeonMichael Olding MD.
First one has to ask the question: Why would someone be offering a procedure at a deep discount?, says Olding. “In business terms, that service is referred to as a “loss leader”(i.e. a product is sold cheap or at a “loss”, to “lead” you to the business where you are likely to purchase other items selling at regular prices,” says Olding. You see it all the time at grocery stores who advertise that a particular product is offered below its traditional value. How can they afford to do that? Well, says Olding, in the grocery store, while you’re there purchasing that product, you will likely be purchasing a lot of other products which makes up for the loss. In the case of a cosmetic surgery Groupon, it may entice you to purchase other more expensive “items” (so to speak), says Olding.
What’s wrong with that? A lot!
“Unlike the grocery store, where you are purchasing a product, even something as simple as botox or fillers have potential complications which can be quite significant and include droopy eyelid (ptosis) and even blindness!” says Dr. Olding. And some people are using counterfeit forms of botox. The take home message is that you need to get it from a reputable physician who can evaluate you based on education, board certification, and experience — all of which are important to consider before having a procedure, even a non-surgical procedure. Failure to consider each of these could save you money initially, but could “cost” you far more, permanent problems, says Dr. Olding.
Education goes hand in hand with board certification, says Olding. And it is not just ANY board. “It is THE American Board of Medical Specialties (ABMS). Although many doctors tell patients that they are board certified, one has to look closer to make sure they didn’t get certified by a board that requires nothing more than a weekend course to be board certified. The unsuspecting public has no idea!” says Olding.
Board certification in Plastic Surgery requires years of rigorous training in an accredited training program and then the candidate must pass an exam at the end of their training in order to be board certified by the ABMS, says Olding. (And a lot of people don’t pass!)
Experience is also important. “I am certified to do cleft lip and palate repairs. I haven’t done one for over 20 years, and I would not attempt one. I do what I have expertise in, and I do it a lot: cosmetic surgery. I could do a groupon for cleft lip and palate, but it would not be unethical from my perspective,” Olding says.
Olding shares there are situations with doctors who may offer flash sales who may claim to do a procedure, but it doesn’t mean they know how to do it, or do it well. Everyone needs to do their homework. The American Society for Aesthetic Plastic Surgery (ASPS) not only requires board certification by the ABMS, but they have to follow a code of ethics, says Olding, and they have to have demonstrated significant experience in aesthetic plastic surgery, so that is often a good place to begin a search. “I would recommend that people use their computers to research the perspective doctor instead of looking for flash sales on it!” says Olding.
Doing your homework
“The most common ways these days to” do your homework” are the computer reviews, word of mouth (from more than one mouth by the way!), recommendations from your primary care doctor, contacting the ABMS , or contacting the ASAPS if they are a plastic surgeon and make certain they are who they claim to be,’ says Olding.
While Dr. Olding doesn’t believe any of the treatments are more acceptable to do via flash site sales, there are ones that are less problematic are the ones that have fewer potential complications. But remember, says Olding, every procedure is potentially dangerous in the wrong hands. “But the potential complications associated with say liposuction or any surgical procedure are in general potentially greater than for say the non-surgical procedures like botulism injections. However, it is important to realize that if the potential complication rate for a procedure is only 1% and you are that 1% that ends up with a permanent problem following a procedure, it might as well have been a 100% complication rate!” Olding says.
July 24, 2015
If you've lost a lot of weight, you may still be burdened with excess skin. Learn how you can remove this skin and dramatically improve the overall shape of your body.
February 20, 2015
As we get older, our skin changes – and with it, our appearance.
I’ve just entered my mid-thirties and things are starting to happen. Lines are appearing where they weren’t before; I have wrinkles and graying roots.
With many years (we hope) of aging before me, it seemed like a good idea to find methods to stop some of the signs in its tracks – and that’s why I tried Restylane Silk.
Restylane Silk is a new “lighter” version of Restylane, meant to make subtle differences rather than more significant ones. In my case, I have noticed what appear to be dry, chapped lips for a while – cognizant that my lips were wrinkling, the choice was clear.
We all want fuller lips – but we don’t necessarily want the “duck lips” we see on some celebrities. Restylane Silk, known for being lighter and softer (hence the silk) sounded like the best of both worlds. Perhaps a subtle plump was the answer.
I visited another professional for my treatment but later, chatted with plastic surgeon, Michael Olding, MD., about this new treatment, who it may be a fit for, and what people can expect when considering taking the plunge themselves.
How does Restylane Silk differ from Restylane "regular"? Is it just basically a "Light" version?
I like that description since the particle size of the material is smaller than that of Restylane. But, they are both hyaluronic acids and are hydrophilic (which means they attract water) and plump up the wrinkle or area not only by their presence, but because they “attract” water.
So what’s the difference between using a lot of Restylane Silk or a regular amount of “regular”?
That’s a good question because it would seem logical to just inject the Restylane in the lips (which has certainly been done with good effect). The theory is that Restylane Silk will plump up those fine wrinkles better, better than other hyaluronic acid products.
We use Restylane Silk for plumping of lips, filling wrinkles around the mouth -- what other potential uses is it approved for? And, who would you recommend it for, or not recommend it for? (i.e., is there an age that is "too young" or a person who is not a candidate?)
It is indicated in submucosal implantation for lip augmentation and implantation in the dermis to correct perioral lines in patients over 21. Therefore, if it is injected in any other scenario, it is considered “off-label”. We all have used injectables off-label. That doesn’t mean it’s illegal, just that the product has not been tested in those other places. That goes for the age too. We can inject in someone under 21, but it has not been tested in this group of patients and therefore we don’t know if it will work in the same way as the over 21 crowd.
How do the costs range, in comparison to other fillers on the market?
It is more expensive than many of the other fillers.
How long do the results tend to last?
Is there anything we can do to make them last longer?
Fillers last longer in areas that are not mobile. In terms of making them last longer in one location like the lips, I am unaware of any way to increase the longevity, however it has been reported that if one injects a second time into the same area, the second injection will tend to last longer than the first.
Any side effects we should worry about?
There are POTENTIAL side effects from any kind of filler. In addition to the typical bruising that could occur with any injection, if injected incorrectly they could get into a blood vessel and cause blindness, but remember this is true for ANY filler, even your own fat. Because they are foreign bodies, you could be allergic to them. Again, like all fillers, you could develop a “granuloma” which is an inflammatory response. If a patient isn’t happy with the results, filler can be removed by injecting hyaluronidase (which breaks down the product and with it the granuloma). Occasionally a steroid or antibiotic can be used to address the side effects.
The procedure itself - I had it, and it just was a little pinch, didn't really hurt - is that the general case?
Pain is so variable from one person to another. Some do not flinch with the injection (but that is a small percentage, usually the ones who have had it before), but for most it hurts as you might expect from sticking a needle in the skin of the lip.
Do you advise any specific pre or after care? For instance, to deal with or ward off swelling or bruising?
I advise no makeup for 24 hours, and ice immediately following the procedure. I also inform them that they will swell for the first 42-72 hours, and that it will improve thereafter.
As for me? I got my lips done a few weeks ago, and I love them – I still look like me, just younger with fuller lips!
December 1, 2014
Dr. Michael Olding comments on "Is Botox for You?" in the March 2015 Men's Journal. Read it here!
August 6, 2014
Are enhanced derrieres the next big thing in plastic surgery? According to statistics, it's a procedure women are getting behind. Dr. Olding comments.
May 6, 2013
Michael Olding, MD discusses if you are a good candidate for plastic surgery after weight loss, as well as the risks and benefits with each procedure.
Dr. Michael Olding, cosmetic surgeon and FDA’s General and Plastic Surgery Devices Panel member, commented on the panel