Confusion Related to Reconstructive Surgery in Modern Society Part 1

March 3, 2010
According to The American Society for Aesthetic Plastic Surgery (ASAPS), seventy-one percent of all Americans would not be reluctant or self-conscious to receive a cosmetic surgical procedure (18). General information indicates that these statistics are remarkably high because of preconceptions about plastic surgery among the general public. Most people view plastic surgery as little more than a person’s attempt to improve his or her looks through procedures such as breast augmentation or rhinoplasty. However, plastic surgery is much more complex than the public realizes. In addition to cosmetic surgery, plastic surgery is predominately occupied by reconstructive procedures which are utilized to address disfigurement and trauma. In reviewing general points, it is clear to see that reconstructive surgery is misunderstood in modern day society; however with effective awareness campaigns and by advocating the copious benefits of reconstructive surgery these societal misrepresentations can be dispelled.
As a human, one of the most basic and primal instincts is progression and change. Dating back to the earliest documentation of history, humans and humanoids alike have had the desire and ability to alter, improve and change their physical surroundings as well as their own body. Practices to enhance ones appearance date back to ancient times and the reign of the Pharaohs (Atiyeh et al). Accordingly, plastic surgery as a whole has developed over a period spanning four thousand years. Progressing from the times of ancient Egyptians, facial wounds received from jousting tournaments during the Renaissance period drove surgeons to constantly update and advance their surgical practices (ASPS). In reference to reconstructive procedures, the knowledge of orofacial clefting was greatly advanced through several publications released from the Renaissance period to the nineteenth century. “The knowledge of cleft lip and the surgical correction received a big boost during the period between the Renaissance and the nineteenth century with the publication of Pierre Franco’s Petit Traite and Traite des Hernies in which he described the condition as “lievre fendu de nativite” (cleft lip present from birth)” (Bhattacharya 4). However, the mainstream prevalence and recognition of plastic surgery began primarily with the development of reconstructive surgery during World War I. Faced with severe facial wounds, mangled limbs and deformed body parts, physicians had to revolutionize their medical practices in order to maintain the wounded soldiers’ health (Subramanian 88). From this, new techniques were shaped in order to treat the maimed soldiers. Common cosmetic procedures such as suction-assisted lipectomy, face-lifts, breast augmentation, etc. have stemmed from original reconstructive techniques developed during WWI (89). Examples of these techniques include skin grafts, craniofacial reconstruction, and contracture surgery. “Surgeons realized the full influence of appearance on individual success” (93). The American Society of Plastic and Reconstructive Surgeons licensing and qualifying board was fashioned and thus began the modern-day history of plastic surgery. Cosmetic surgery, or the enhancing of one’s appearance, did not make its debut into mainstream society until the unveiling of the liposuction technique in 1974 (Physicians Guide to Cosmetic Surgery). Thus beginning society’s myopic view of reconstructive surgery.

The general public is constantly undergoing many societal shifts in regards to modern-day cosmetic surgery. The prevalence and views of aesthetic surgery throughout all of the populous regardless of age, gender, race etc. shows that no longer is cosmetic surgery used solely to increase self esteem, but also used to enhance economic and social status. “Youth is associated with power, status and control. Cosmetic surgery is used to preserve youth thus preserve their wealth, affluence or acceptance in society” (Lowe 36). Losing sight of medical values, society has begun to assimilate the aesthetic surgical community with the modern day beauty industry. This generalization of aesthetic and cosmetic surgery is evidence of modern medicine’s general shift from the central purpose of healing patients through the alleviation of suffering and eradication of disease to the fulfillment of patient wishes and desires (Atiyeh et al). In Dr. Bellieni’s article “Pleasing Desires or Pleasing Wishes? A New Approach To Health Definition” he references Dr. B. Brülde and his seven goals of medicine “To promote functioning, to maintain or restore normal structure and function, to promote quality of life, to save and prolong life, to help the patient cope well with their condition, to improve the external conditions under which patients live, and to promote the growth and development of children” (Bellieni 1 et al.) However, with this warping of medical standards the less ethical within the cosmetic surgery community are profiting from vanity, youthfulness, and personal success (Atiyeh et al). By making fulfillment one of main focuses of medicine aesthetic surgery is threatened to become a mere consumer product rather than a medical act. Additionally, the increase in media persuasion, with reality shows such as “The Swan”, “Miami Slice” and “Dr. 90210”, implicates that cosmetic surgery is the only faction of plastic surgery. Societal shifts are also becoming more prevalent in today’s youth. Traditionally, for graduation presents teenagers may be given items including money, a car, or items for college. However, now students are bestowed gifts such as liposuction or breast implants for graduation gifts (Gilbert 14). This societal modification, among others, has caused many countries abroad to stereotype American citizens as being over indulged and too obsessed with individual appearance (Piccalo 7). In regards to a case study conducted by Dr. A. Noyan, “Variables Affecting Patient Satisfaction In Breast Surgery: A Cross-Sectional Sample of Turkish Women With Breast Cancer”, he concluded that even in countries abroad, such as Turkey, reconstructive surgery is commonly assimilated with cosmetic surgery. “It should be noted that the Turkish population has a negative attitude toward reconstructive surgery in general and breast reconstruction is confused with aesthetic surgery, and therefore perceived as mere vanity in Turkey” (Noyan 301). This shows that our communal mindset of beauty may not only be another’s definition of repulsive, but also this mindset may vary and fluctuate greatly when traversing the various regions of the globe. “With society putting too much emphasis on physical attractiveness and the bias in favor of good looks being so widespread and discriminatory, often beauty can be ugly” (Wolgemuth 68). Increasing societal use of cosmetic surgery can also be accredited to the rising availability of cosmetic procedures. Minimally invasive procedures can be performed within the confines of office practice. The top minimally invasive aesthetic procedures in 2008 were Onabotulinumtoxin A (Botox) injections, dermal filler injections, laser hair reduction, chemical peels, laser skin resurfacing, microdermabrasion, and intense pulsed light photorejuvenation (Appendix A) (Small 2). These procedures coupled with readily available surgical procedures have attributed to the seventy-one percent of Americans who stated they would receive cosmetic surgery. All in all the goals of a cosmetic procedure are for the patient to be content with their self-image and possibly have an increase in their self-esteem, however due to the ever-fluctuating human approach, the goals of cosmetic procedures have been warped by society. People of all ages may now visit cosmetic surgeons hoping to achieve the definition and epitome of beauty, which is clearly not the genuine purpose of undergoing an elective cosmetic procedure.

Though once used for correcting damage done to an individual’s face or body, cosmetic surgery has now been refashioned to fit modern society. Corrective procedures such as face-lifts or breast augmentations are being used to correct damage done by extrinsic aging factors. Such factors include sun exposure, repetitive facial expressions, gravity, smoking and sleeping positions (Subramanian 89). “In fact, most so-called “cosmetic surgery” procedures are actually extensions of complex reconstructive surgery that plastic surgeons train for years to perfect” (Atiyeh et al). In reference to fat grafting, this is a prime example of a dual reconstructive and cosmetic procedure. “A renewed interest in fat grafting for both reconstructive and aesthetic purposes has prompted plastic surgeons and other medical practitioners to perform such procedures” (Gutowski et al). Originally utilized for the correction of medical induced defects, congenital or developmental defects, autologous fat grafts are now utilized in breast augmentations (micromastia), lip augmentation, gluteal augmentation and contour, and facial augmentations such as malar augmentations (cheek implants) or rhytidectomys (face lifts) (Gutowski et al). Patients receiving procedures such as breast reductions or breast reconstruction, due to situations such as breast cancer, may be considered cosmetic from societies view because of a myopic view of plastics medicine. Focusing solely on the aesthetic/cosmetic spectrum, patients are choosing these elective procedures in order to preserve their youth, refusing to accept the physiological changes associated with aging. “With modern advancements in cosmetic surgery, many individuals believe beauty and youth can be purchased and all aspirations achieved” (Bradbury 42). General analysis indicates that the most prevalent reason society turns to cosmetic surgery is belief that an advancement in appearance will overall lead to an increase in self-confidence. These elevated levels of self-confidence may lead the patient to believe they will be more accepted in society, or possibly obtain higher paying jobs (Kendall 9). Regardless of the reasons or justifications people have for turning to cosmetic surgery, increasing societal trends within cosmetic surgery have clearly undermined the importance and significance of reconstructive surgery in modern society.

Concerning the psychological side of cosmetic patients in junction with ethical debates, a strong correlation between plastic surgery and psychiatry has blossomed in recent years. Patients who suffer from psychological disorders, or an altered mental status regarding self-image may feel the need and desire to turn to cosmetic surgery. This situation is when the line between cosmetic surgery and psychiatry become blurred and proper patient selection from the surgeon becomes a major factor. “A closer look from an ethical viewpoint makes clear that the doctor who offers aesthetic interventions faces many serious ethical problems which have to do with the identity of the surgeon as a healer” (Aityeh et al). Disorders such as Body Dysmorphic Disorder or Dysmorphophobia cause an individual to possess a fixed and delusional belief about a physical defect they have and are not amenable to reasoned discussion (44). Its commonality and severity coupled with depressive disorders, substance abuse disorders, obsessive-compulsive disorder and social phobias craft the self-image disorder of Body Dysmorphic Disorder (Phillips). Patients who demonstrate distressing or impairing preoccupation with an imagined or slight defect are often the primary victims of Body Dysmorphic Disorder. Because of these inflexible self-image shortcomings or imagined defects patients who are denied by cosmetic surgeons may turn to less ethical surgeons or surgeons abroad. These surgeons may be viewed as “cut first, question later” surgeons and do nothing to help the patient’s mental status (Philips 112). Thus, because of the variety of disorders associated with Body Dysmorphic Disorder, I.E substance abuse, depression, obsessive-compulsive disorder, and social phobias, correcting the perceived self-image shortcoming does nothing to affect the patient’s psychological state. Though the physical aspect of Body Dysmorphic Disorder patients might be treated, the patients underlying psychological problems persist, causing a potential relapse of imagined defects in appearance. Patients suffering from psychological disorders such as Body Dysmorphic Disorder further modern society’s need to achieve perfection and beauty. The fixed delusional belief Body Dysmorphic Disorder patients suffer from has the capability to influence other people to question their own physical appearance. They too might visit a cosmetic surgeon for appearance enhancing procedures for the wrong reasons. Other concerns present within the psychiatry field are patients who are dissatisfied with their surgical outcomes. “A study, published in the Annals of Plastic Surgery, reinforces several others that have shown women who have breast enlargements for esthetical purposes have higher suicide risks” (Bellieni 9 et al). Although suicide is an extreme adverse reaction, many psychological problems can manifest from poor outcomes of aesthetic/cosmetic procedures. “The researchers found that patients who are dissatisfied with surgery may request repeat procedures or experience depression and adjustment problems, social isolation, family problems, self-destructive behaviors and anger towards that surgeon and his or her staff” (Dittmann 30). Although success within the aesthetic community is based off of patient satisfaction, ultimately, from a physician’s standpoint, the major determinant for a successful surgery remains proper patient selection.

Psychological concerns are not the only driving factor in growing cosmetic and aesthetic trends. Medical tourism or cosmetic surgery tourism is “the practice of patients seeking lower cost health-care procedures abroad, often packaged with travel and sightseeing excursions” (Tompkins). Patients seeking to receive cosmetic surgical procedures outside the United States often fall victim to the appeal of cosmetic surgery tourism. This price driven phenomenon allows citizens to travel to developing nations and receive cosmetic procedures at either a cheaper rate than within the United States, or to receive procedures they may have been denied from by American plastic surgeons. Additionally, American citizens can sidestep insurance companies through the utilization of cosmetic surgery tourism “Americans opt for surgery abroad because of the exorbitant prices of medical procedures not covered by insurance” (Cassanova 3). Many physiological coupled with physical risks accompany cosmetic surgery tourism. Traveling in combination with major aesthetic procedures often increases the risk of pulmonary embolisms, hematomas, and blood clots when in transit for extended periods. Due to the nature of the term vacation, people who choose to travel abroad for cosmetic procedures often do not rest the appropriate amount of time before traveling, or engaging in other common vacation activities. Patients who participate in activities such as sun bathing, the consumption of alcohol, swimming, snorkeling, water skiing, jet skiing, parasailing and extensive walking or bus tours may lengthen the recovery time as well as not allow for a proper recovery (ASPS). In regards to activities involving exposure to water, early water exposure to wounds increases the risk of infection as well as unsightly scars (Cassanova 7). Another drawback to cosmetic surgery tourism is patients who obtain unsatisfactory results often receive little to no follow up care when they return to the United States. This shortcoming is attributed to the lack of qualified surgeons and the unfamiliarity of surgical techniques the foreign surgeons may have utilized. “Surgery is serious and the degree of risk is increased with distance and unfamiliarity with resources” (Tompkins). Additionally, patients who receive sub par aesthetic results may feel compulsory to travel abroad again to receive either a follow-up surgery or an additional cosmetic procedure (Phillips 111). This swiftly growing phenomenon has no regards for the patient’s mental status and is one of the many catalysts for further societal

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