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The Shape of Confidence
Options and affordability give lift to cosmetic surgery field.

She was 17, a native of the Ukraine and, because of her appearance, so introverted that she did not want to appear in public. The teenager and her parents had sought out Dr. Devinder Mangat, an Edgewood, Ky. plastic surgeon, to see if he could remedy the horrendous scar that covered half the girl’s face. The initial problem was a birth defect, further complicated by radiation therapy as Russia, at that time, could offer only x-ray treatment rather than reconstructive plastic surgery.

“Initially, I did three procedures,” Dr. Mangat explained. “The first stage was a tissue expander to create more skin. Then, after about two months, I did the first reconstruction and, six weeks later, a follow-up procedure.”

In all, some four years was required to reconstruct the patient’s face. It was one of the most difficult surgerical procedures undertaken by Dr. Mangat, immediate past president of the American Academy of Facial and Reconstructive Plastic Surgery. But, it was one of the most rewarding.

Dr. Mangat, a facial plastic surgeon, continues to get letters and visits from his young patient, who’s now 24 and a physician’s assistant in Canada. She never fails to mention how Dr. Mangat changed her life, that she’ll never forget him for what he did for her.

“There’s really only one reason to do plastic surgery,” Dr. Mangat commented. “And that’s what it will do for the patient – make them feel better about themselves, give them confidence.”

Whether it’s reconstructive or cosmetic, plastic surgery is a growing surgical field in the United States. In 1999, according to information from the American Society of Plastic Surgeons (ASPS), nearly 2.3 million plastic surgery procedures were performed. The total covers 32 cosmetic and reconstructive procedures, including tumor removal, liposuction (reduction of fatty deposits), hand surgery, breast augmentation and blepharoplasty (eyelid surgery).

And, since 1992, the number of individuals having cosmetic surgery procedures nearly tripled. Liposuction, the most commonly performed procedure, increased nearly five times as did breast augmentation. Eyelid surgery doubled during the eight-year span, facelifts were up 82 percent and abdominoplasty (tummy tucks) tripled.

It’s anticipated that these numbers will continue to grow. Dr. Martin Luftman, who’s been practicing in Lexington for nearly 20 years, said his practice “probably has doubled over the past 10 years.” And Dr. David Kirn, another Lexington plastic surgeon, has experienced substantial growth although he has been in practice for slightly less than three years.

“More and more people are having cosmetic surgery because they want to look better for professional reasons,” says Dr. Mangat. “They want to remain competitive in the job market longer.”

Individuals who have had plastic surgery, particularly cosmetic procedures, are proving that it does a great deal for them psychologically. Dr. Donn Chatham, who practices in Louisville and Southern Indiana, points out that, initially, “the most rewarding thing for the surgeon is when things (the procedures) have gone well.” The secondary payoff, is “when the patient expresses that they’re glad they did it and they’d to it all over again.”

Rhinoplasty, or nose surgery, is another good example of how perceptions and attitudes can be changed positively, Dr. Mangat added. This procedure, he said, now accounts for about 20 percent of his practice.

“The teenager with a big nose often is very shy, introverted, doesn’t go out much and you find in conversation with him or her that the nose has a lot to do with it. After they go through the rhinoplasty and when you see them afterward – I’m not exaggerating – they suddenly have a personality.

Older persons, having raised their families, also are exploring plastic surgery, Dr. Mangat said.

“What they see in the mirror doesn’t please them,” he continued. “They see a person who is sad, tired and not happy-looking. So, you do surgery on this person, transform their appearance. But, the physical change is only part of it. The other factor that makes them look better is how they now begin to feel inside.”

Cases such as that involving the Ukranian teenager made Dr. Mangat realize that plastic surgeons do heal and help people. Another was a situation involving a young lady kicked in the face by a horse. The incident had left an otherwise attractive young girl with a deformity of the nose, an area that was sunken and depressed. She and her parents couldn’t afford the reconstructive surgery. The student finished high school, got a job and, still bothered by her appearance, came to see Dr. Mangat.

“I immediately sensed her withdrawn personality and how important a correction was to her,” he related. And, he added, contrary to what some may think, plastic surgeons don’t just operate on wealthy people.

“We were able to get her insurance to cover a significant portion of her surgery because it was related to an injury,” Dr. Mangat explained. He then “wrote off” the balance of the cost so she wouldn’t have to pay anything out of pocket.

Finances are not as much of a problem with plastic surgery as some may believe. The ASPS points out that while insurance companies don’t pay for cosmetic plastic surgery, they should cover reconstructive operations. In addition, there are a number of patient financing programs available to those wanting and needing cosmetic procedures. And, often, the cost is not as great as some may think.

According to ASPS information, the two most common facial procedures – rhytidectomy (facelift) and rhinoplasty (nose) – have an average cost of $5,200 and $3,700, respectively. And, an abdominoplasty (tummy tuck) can average about $4,200.

Those costs don’t reflect such additional fees as anesthesia or, possibly, the operating facilities, but, as Dr. Luftman points out, “plastic surgery is still reasonably affordable.”

“It’s not like $50,000, it’s going to be something on the order of $4,000 to $10,000, depending upon what a patient chooses,” he concluded.

Dr. Mangat does virtually all of his procedures at his accredited surgery center in Edgewood, where he has three operating rooms and four recovery rooms. He also has an office in Cincinnati and another in Vail, Colo. He’s in Vail about once a month for four or five days at a time and does some surgery at a hospital there. The three locations also result in a very diverse patient clientele, which includes a number of celebrities.

Women’s magazines also have devoted more coverage to the surgery and its appearance-improving benefits.

“When I first went into practice, people wouldn’t talk much about having had cosmetic surgery,” Dr. Mangat, who has been practicing for 21 years, noted. “Cosmetic surgery was done quietly, and often people went away to do it.”

The media coverage has changed that, putting any taboos aside.

“In the last five years, the influx of the baby boomer population has made cosmetic surgery particularly popular,” he added, “and another factor is the fitness craze that started to take off about 10-12 years ago. .

“And, as cosmetic surgery has become more accepted and available, it also has become safer, much more refined and more perfected. All these things, I think, have combined to make it as popular as it is today.”

In the late 1970s, Dr. Mangat said only about seven percent of his patients were men. Now, it’s about 15 percent.

“Men are having some of the same procedures that woman have – facelifts, eyelid lifts and rhinoplasties. However, they don’t have chemical or laser peels to remove wrinkles, because it’s acceptable for men to have some wrinkles.”

Generally, people are more health-conscious, Dr. Mangat said.

“But, if you read the national statistics, they tell you we’re a more obese nation than we were a decade ago. I think some of that is related to socio-economic levels, and also geography. In my Vail practice, it’s rare for me to see someone who’s overweight and it’s unheard of to see a smoker. In that area, people generally are younger, more fitness- and outdoor-oriented and in great health. This makes my job easier because they heal quicker and there are fewer problems.”

Plastic surgeons are very selective about who they operate on, Dr. Mangat acknowledged.

“It’s important that those considering cosmetic surgery, number 1, be in good physical and mental health, number 2, be properly motivated and have realistic expectations, and, number 3, they should be doing the procedure for the right reasons.

“Smoking, drinking and poor diet can affect people’s health and the skin tissues that reflect how they look and how fast they age. And, there’s no question that excessive sun exposure speeds up the aging process and appearance of skin cancers. Air pollution, without a doubt, affects the skin as it can clog the pores and make it unhealthy, lessening the turnover of dead cells and skin regeneration.”
But, how do you choose a plastic surgeon?

Dr. Randolph Waldman, a Lexington facial specialist, emphasizes that it’s important to find a surgeon with whom you can communicate well. And, he added, ask surgeons for before and after photos of other patients who have undergone the procedure you’re considering. Then, talk to other patients who’ve already had the procedure.

Dr. Chatham suggests calling two or three offices and see how you’re treated by the person who answers the phone. That staff person, he said, often reflects the personality of the physician. Also, ask about the surgeon’s training, how long they’ve been in practice and if they have hospital privileges.

Plastic surgery board certification is another consideration where training and expertise are concerned. Surgical residences ranging from five to six years, plus successful completion of oral and written exams are required by the American Board of Plastic Surgery and the American Board of Otolaryngology. Additional certification by the American Board of Facial and Reconstructive Surgery requires two years of clinical experience, a minimum of 100 facial plastic surgeries and an examination.
Although Kentucky is not one of the primary states for cosmetic and reconstructive procedures, the surgery is becoming more common here, Dr. Kirn said. Dr. Waldman is even more emphatic about the area’s expertise, particularly in Lexington which, he said, has an excellent group of plastic surgeons.

“We try to make sure people are doing the surgery for the right reasons,” Dr. Luftman commented. “It’s not going to save a marriage, but if people are doing it for themselves and their own self-image and outlook, it’s a very positive thing.”

“I can’t put a smile on their face with surgery,” Dr. Mangat said of his patients. “But the resulting infusion of confidence can.”

Ed Ford is a staff writer for The Lane Report.
editorial@lanereport.com

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