ASPS Report Shows Breast Augmentation Top Procedure - Buttock Enhancement and Neck Lift On The Rise

by Andrea L. Algar

More and more Americans are opting to enhance themselves with plastic surgery and cosmetic procedures. According to a new report from the American Society of Plastic Surgeons (ASPS), cosmetic surgery procedures in 2013 were up 3% from the 2012. 15.1 million procedures were performed.

Not surprisingly, breast augmentations and nose jobs (rhinoplasty) are still the most popular surgical procedures. More surprising is how sharply buttock enhancements have risen.  Almost 10,000 procedures took place in 2013, which represent an increase of 16 percent from the previous year. 

According to Dr. Robert Young, "Breast Augmentation continues to be the number one procedure I do. The Brazilian Butt Lift is also a very popular procedure in my San Antonio Surgery Center. I've noticed a sharp increase in them over the last two years. I think women like it because you're eliminating problematic fatty areas (usually the abdomen, hips or thighs) with liposuction, while adding desired volume to the buttock." Also of interest was that neck lifts also rose sharply with more than 55,000 neck procedures performed last year.

In a press release by the ASPS, President Dr. Robert Murphy said, “The demand for plastic surgery remains strong, with our statistics showing increases in both cosmetic surgical and minimally-invasive procedures… With new devices and products hitting the market each year, there are more options and choices available to consumers wanting to refresh their look or a little nip and tuck."

What does this mean for the average consumer? 

Plastic surgery procedures are far more accepted by society than in decades past. Women talk much more openly about procedures they want or have had. The Internet is alive with forums where patients can share stories, ask questions, and get information. RealSelf.com has emerged as a leader in this. With today's world of competitive work environments, even men are getting into the act. Procedures for men are on the rise, and men are losing the fear of having procedures done to enhance their looks or reverse the signs of aging. 

New products, devices and technologies are coming into the plastic surgery field every year that help to make cosmetic procedures more attractive to men and women. There are more options and choices available for everyone. At the same time, because of this, it's more important than ever to research procedures you are interested in and find qualified professionals. The ASPS, ASAPS and other professional associations recommend seeking services from a Board Certified plastic surgeon who has experience with those procedures.

Should My Plastic Surgeon Be Board Certified?

There's good reason to check whether your plastic surgeon is Board Certified. Too often, news emerges with stories of patients who elect to go to providers who may not have the qualifications to perform cosmetic procedures or surgeries. With the popularity of cosmetic plastic surgery, it can attract unqualified (and sometimes unscrupulous) people who are lured by what they see as quick profit.

In some cases, the service provider may not even be a legitimate doctor. There have been several stories this past year about people posing as doctors and performing non-surgical procedures as well as actual surgeries in hotel rooms or back offices. There have been cases of people being injected with non-medical ingredients such as cement or silicone directly into the breasts, buttocks and even the face. These are highly toxic and can be extremely caustic, causing burns, infection, serious wounds and even disfigurement. Botox® and facial fillers are being used by people who have no training in facial nerve structure or the underlying muscles of the face, and mis-use of these products can result in droopy eyes, temporary paralysis, and even nerve damage.

In other cases, it may be a doctor who does not have sufficient training in this specialized field. They may be a generalist, gynecologist or other physician who has no formal training or experience in plastic surgery. They may have simply taken a weekend course in breast augmentation or liposuction and may have little experience with surgery. Generally people undergoing any type of surgery want someone with specialized training and competence.

Some are turning to the trend in "awake" surgeries. Procedures performed while the patient is "awake" can be risky if they do not have the equipment necessary to monitor a patient, do not have emergency equipment necessary to resuscitate a patient should there be a complication or if a licensed anesthesiologist is not in attendance during the surgical procedure. Even though the patient may be "awake", it does not decrease the risk associated with the sedation medications that patients are given. It is still surgery!

Tourist or vacation plastic surgery is also seeing an increase as those who want cosmetic surgery but don't want to or cannot pay the going rate seek alternatives. We've seen women who have flown to a foreign country such as Mexico, Asia or South America to receive a $2,000 tummy tuck and now have complications such as severe infection or a poor outcome that could cost many more thousands to try to correct. It is rare to receive appropriate pre-operative and post-operative care at foreign facilities, with patients eager to get on with the vacation end of their trip, or in getting back home, putting themselves at even greater risk of complications. It is usually recommended that you do not fly for at least 2 weeks or more following any type of surgery, and cosmetic plastic surgery is no exception.

So what is the difference between an internist and a plastic surgeon?

Obtaining a medical license to diagnose and treat patients means a physician meets a minimum level of competency requirements to become a doctor, but it is not specific to any one specialty. Board Certification demonstrates a level of expertise in a specialty and is considered the "Gold Standard". Board Certification by the ABPS ensures that the surgeon has had at least six years of surgical training, years of surgical experience, has passed both oral and written exams and has had surgical cases reviewed by the Board in order to demonstrate proficiency within the field of plastic surgery. They certify that they only operate in accredited medical facilities such as hospitals and accredited outpatient surgery centers. They are licensed physicians who have made a choice to make plastic surgery their primary focus as a medical professional.

Robert N. Young, founder of Aesthetic Enhancement Cosmetic Surgery & Laser Center, is a Board Certified Plastic Surgeon with over 30 years experience. He has been trained and has extensive experience both as a reconstructive plastic surgeon and a cosmetic plastic surgeon. As a leading breast augmentation specialist in San Antonio, Texas, Dr. Young is a member of the following professional organizations:

• ABPS Diplomate - Board Certified by The American Board of Plastic Surgery (ABPS)

• Member, American Society for Aesthetic Plastic Surgery (ASAPS)

• Member, American Society of Plastic Surgeons (ASPS)

• Fellow, American College of Surgeons

• Member, Texas Medical Society (TMS)

• Member, San Antonio International Society of Plastic & Reconstructive Surgery (SAISPRS)

• Bexar County Medical Society (BCMS)

• Accreditation by the American Association for Ambulatory Surgical Facilities (AAAASF)

Dr. Robert N. Young encourages patients to take the time to check the credentials of anyone you're considering for cosmetic surgery procedures. The two major societies, the ASAPS and ASPS are good resources for more information about plastic surgery and Board Certified Plastic Surgeons around the country.

REFERENCES / RESOURCES FOR MORE INFORMATION:
Herald Tribune - Plastic Surgeons Warn of Trade's Dark Side
Locate A Doc - Cosmetic Surgeon Imposter Jailed for Practicing Without a License
The Baltimore Sun - Health Officials Alarmed Over Silicone Injections For Fuller Buttocks
The Smoking Gun - Silicone Sister Busted For Butt, Hip Injections
USA Today - Lack Of Training Can Be Deadly In Cosmetic Surgery

Dr. Young's recent trainings

Dr. Young recently returned from the Las Vegas Convention for plastic and reconstructive surgeons.  There were many topics of discussion that Dr. Young found interesting.  He feels that attending meetings which are hosted by your professional associations (such as the ASPS and ASAPS for Board Certified Plastic Surgeons), challenge you to keep abreast of the latest advances and technologies available in your field. The opportunity to meet with colleagues, attend seminars and trainings, visit with manufacturers and vendors is vital in keeping you well informed and able to deliver the best to your patients.

I'm afraid of anesthesia...is the "awake" method good for me?

by Robert N. Young, M.D.

Board Certified Plastic Surgeon

We've seen a new trend in Cosmetic Plastic Surgery...promotions of "Awake Breast Augmentations".  It is talked about as something new, but in actuality, surgeries performed under "local anesthesia", or "twilight anesthesia" have been around for many years.  Whether it is a good choice for patients is being hotly debated.

Because Breast Augmentation has become such a popular procedure, and is more readily talked about by society, some feel it has become somewhat frivolized.  It is easy to forget that this is still a major surgical procedure. While endoscopic (minimal incision) techniques have made the surgery less invasive and easier to recover from, the procedure is best done under general anesthesia with a Board Certified Anesthesiologist. "Twilight anesthesia" can be dangerous without an anesthesiologist present.

There is quite a bit of debate recently about practitioners who are advertising "awake" surgeries.  These are usually performed by physicians who are not Board Certified Plastic Surgeons, and may not even be Plastic Surgeons at all.  Sometimes they are Dermatologists, General Surgeons, or even Family Practitioners who elect to perform the surgery under local anesthesia because they do not have  privileges in a hospital or certified surgery center to perform those procedures. In my Surgery Center, all anesthesia is administered and monitored by Board Certified Anesthesiologists who are experienced in Cosmetic Plastic Surgery.  I feel this is best for my patients, and myself, as it allows me to concentrate on my area of expertise, which is the surgery itself.

My Surgery Center is fully certified by the AAAASF and meets strict standards to perform surgical procedures. Sure, the surgery costs a little more, but it is worth having the extra standards and safety factors. That's why doctors are credentialed and surgery centers are certified. If we didn't adhere to these standards we would be cheaper also. So when you get a fee quote that is cheaper because it is under local anesthesia in an office back room, be careful of what you are asking for.

Board certification by an ABMS member board provides assurance of a physician’s expertise in a particular specialty and/or subspecialty of practice. Professional organizations, such as the American Society of Plastic Surgeons (ASPS), the American Society for Aesthetic Plastic Surgery (ASAPS) require that members be Board Certified within their specialty.

Some advertisements even go so far as to state that you'll be awake enough during your procedure to pick the size of your breast implants (this would only be possible with saline implants which are inserted and then filled to the desired size) during your surgical procedure itself!  If you have had sedation you are going to feel woozy and wobbly.  I don't think you would be coherent enough to make this selection during surgery!

We recommend that you ask questions that will ensure that you are well informed concerning the qualifications and experience of your surgeon and the types of anesthesia that you are offered.  Here are questions generally recommended:

• Are you Board Certified? 
• If so, what specialty board?
• Are you licensed to practice surgery in this state?
• How many breast augmentation surgeries do you perform each year?
• How many years have you performed breast implant procedures?
• Where is my procedure performed?  
• Is the surgical facility accredited?
  
• Who administers anesthesia during my surgery?
• Is the person who administers my anesthesia Board Certified in this specialty? 
  
• What are my options for anesthesia?
  

When you come in for a consultation visit with me, I will make recommendations based on my extensive experience as first a reconstructive and then cosmetic plastic surgeon. I invite you to ask questions regarding various surgical methods, anesthesia, recovery and any other questions you may have so that you can make an informed decision about your surgery.  You may contact my office at 210-496-BODY (496-2639) or e-mail me at nubody@dr-youngforever.com.

How do I get started?

We receive many e-mails.  As you might imagine, some are routine inquiries about cost of Cosmetic Plastic Surgery procedures or how long one would need to take off of work.  At other times, however, we receive really great questions.  We'd like to share these, and we will publish ones we feel that our patients and friends will benefit from. To get things started, we'll share a very common one.

This was an e-mail received from Andrea in September 2009:

"Hello. I am very interested in getting my breasts done.  I've heard good things about Dr. Young and have seen many women who've had their procedure done by him.  How do I begin the process?"

We always encourage you to schedule a consultation visit with Dr. Young so that he has an opportunity to examine you answer questions you have, and make recommendations.  There are things you can do ahead of time to ensure that your consultation visit is as helpful to you as possible.

I always recommend that you make a list of all your questions.  And, add to the list as you think of other concerns or questions...no matter how silly they may seem.  Some information you'll be able to obtain from quality internet sites.  I prefer to lean towards information sites rather than "locate-a-doctor" referral sites. Information sites include plastic surgery association sites, implant manufacturer sites, and encyclopedia style sites such as:

American Society of Plastic Surgeons
http://www.plasticsurgery.org/

The American Society for Aesthetic Plastic Surgery

http://www.surgery.org/

Good encyclopedia style sites include:  howstuffworks.com, webmd.com, wikipedia.org, medicinenet.com, ezinearticles.com, and ehow.com.  You can look up your specific interests and learn about the procedures. Here are some sample links that would be helpful for Breast Augmentation research:

http://health.howstuffworks.com/breast-implant.htm/printable

http://www.plasticsurgery.org/Patients_and_Consumers/Procedures/Cosmetic_Procedures/Breast_Augmentation.html

http://www.implantinfo.com/

http://www.loveyourlook.com/

http://www.webmd.com/skin-beauty/cosmetic-procedures-breast-augmentation

http://en.wikipedia.org/wiki/Breast_implant

http://www.medicinenet.com/breast_augmentation/article.htm

http://ezinearticles.com/?Various-Views-on-Breast-Augmentation&id=3212987

http://www.ehow.com/about_5402302_breast-augmentation-information.html

Once you've had a chance to read through the information you'll undoubtedly have questions in how this information relates to YOU!  This is what is especially helpful in a consultation visit with Dr. Young.  There are many choices then it comes to surgical procedures.  An experienced, qualified surgeon like Dr. Young can help you make choices that are most appropriate for YOU, and not just what is popular at the moment.  (It is widely recommended that you seek out an experienced surgeon who is a Board Certified Plastic Surgeon, as they are physicians who have undergone years of additional training in this specialty.  They must pass strict criteria once completing this training, as well as show documented experience to demonstrate their abilities. I've been told that only 30% of those applying for this designation pass.) Great results and your satisfaction are what we want most.  We can help sort through the sometimes confusion array of surgical methods, incision locations, type of anesthesia etc.

You will have an opportunity to meet with Dr. Young, as well as his nurse(s) in your consultation.  Dr. Young's nurses are very familiar with the procedures he performs and not only assist Dr. Young in clinic for new patient consultations and follow up visits, but have regular duties in the Operating Suite as well.  Most of our nurses have been with Dr. Young for five years or more, and several over ten.  They can be instrumental in helping you understand the surgical procedure, coordinate after-surgery care, etc.

Your Consultation Visit is an exciting time because the possibilities are quickly seen as a reality. It is easy to overlook an important question or even feel too embarrassed to ask a question that seems silly or awkward. Making a list of your questions or concerns helps keep you focused, and ensures you'll be more ready to make a decision on whether the procedure is right for you. 

In Andrea's case of wanting to prepare for a Breast Augmentation, she would begin by scheduling her consultation appointment.  At her consultation, she will meet with Dr. Young, and one or more of his nurses for an examination, discussion of the procedure, recommendations, and a "sizing" prior to speaking with her surgery coordinator. 

The sizing is her opportunity to "try on" many different size implants in a special bra.  Andrea can then get a sense of what style and size implant is most appropriate for her.  Every woman's body type is different, and one's taste in size is different.  We encourage you to select your size based on what feels best to YOU.  You might hear from a friend that she had 450cc implants, and you think that you'd like to be that size, or maybe even a bit bigger.  Keep in mind that 500cc implants in someone who is 5'7" tall and weighs 135 pounds will look quite different on someone who is 5'2" tall and weighs 110!  Are you broad shouldered, narrow chested, pear shaped, tall or petite?  Your body type will play a big part if you're trying to achieve a more balanced, proportional look.

After the consultation visit, if a surgery date is selected, Andrea will also schedule a "pre-op" (pre-operative) visit which is usually two weeks prior to the surgery, but may be closer to the date of surgery if you schedule for a more immediate surgery (surgeries can be scheduled as soon as the following day in some cases).  At this visit she will go over her medical history with one of Dr. Young's nurses, have a physical exam with vitals and labwork performed, discuss risks, how to prepare for surgery and recovery, among other things. It is Andrea's chance to ask any other questions she's thought of as well, and to finalize the size of her implants.  The next time we see Andrea will be the day of her surgery, which is performed in Dr. Young's fully accredited in-office Surgery Center.  Our OR staff will be there for each stage of her procedure, including instructions for Andrea's friend or family member who will drive her home following her recovery.

I hope this information gives you an idea of how things can proceed once you've decided you'd like to look into cosmetic plastic surgery.  I'd like to thank Andrea, and everyone who sends us great e-mail questions.  Please continue to do so.  You can e-mail me directly at:  busmgr@dr-youngforever.com.