Excerpt from Dr. Max Sawaf’s book "Vitality for Life"
Thinking of having a little nip and tuck? Here are some things to think about before surrendering to the surgeon's scalpel.
You can start with a good skin health restoration program using medicated cosmetics that suit your skin under medical supervision instead of buying worthless cosmetics or dreams in a jar. You can use Botox® for wrinkles around the eyes and forehead, fat transfer or hyaluronic acid for the fold between the mouth and the cheek, superficial chemical peels to renew the skin and treat pigmentation spots, micro-dermabrasion or non surgical ND: YAG laser facelifts, the newer version of he Fraxel laser or the enhanced new thermage.
How does one go about choosing the right surgeon?
It depends on your needs of course but there are a few things I've learned during my journey that I would like to share.
It is impossible to hold a medical degree from the University of SukuSuku as SukuSuku is not a country; you should never have to walk through a pest control shop to get to the clinic and avoid places that require a secret knock!
Clean, well appointed premises are a good sign and you can tell a lot about the surgeon by his clients and his staff. If the surgeon has a lot of happy people in the lobby consider that a good sign.
Once I've found the right doctor what then?
Be specific about your needs and don't take no for an answer. Remember, like a housepainter, a plastic surgeon works for you. Just as you wouldn't let a housepainter say "No, I think it looks good now. I refuse to do any more work as it would be dangerous." You should not let a surgeon bully you. Make a clear list of what you want. If they cannot deliver, tell them you will get someone else to do it.
Bring in a photograph, to show the surgeon exactly the look you desire. Unless you have a knack for drawing, don't make the Joan Rivers mistake of handing in a sketch on a cocktail napkin.
Make sure you are going to get value for your money. Michelle Pfeiffer, Michel Jackson, Lauren Hutton are just three examples of people who were taken for thousands of dollars yet have very little to show for it. If the only comments you get after you've invested thousands are "My God, you look rested" or "did you get your hair cut?" then you have not received your money's worth. Would you spend $50,000 on a tune-up for your old car? No, you would get a brand new one. The same thing applies here.
How much should I pay?
Most good plastic surgeons and plastic surgery centers are more expensive than someone who is not as experienced. When a surgeon is slow because he is not experienced or not as good, he would be willing to pay money for the patient to do the operation to gain experience! Beware of surgeons and centers offering services much cheaper than the going rates in your community. On the other hand, not every expensive surgeon is a good surgeon. Unfortunately, I get too many patients who call my Centers asking do you do gastric bands or nose reshaping surgery, and when we say yes their next question is “how much does it cost”. While this is an important question, it should not be the first consideration. Cheapest can turn out to be very expensive. We are talking about your most precious asset, your face, your body and your health. Also make sure you are comparing apples to apples i.e. what is included and what is excluded in the price (Click on Pricing on our website).
How safe are the most common procedures?
All surgeries carry some risk of infection and the risk of anesthesia. Since we opend our hospital in 2004, we have performed over 21,000 surgeries in our Hospitals in Dubai and Abu Dhabi without a single death. We generally only use general anesthesia for few operations such as breast reduction, certain nose surgeries and gastric band surgery and frequently use spinal anesthesia for liposuction and tummy tucks.
By far the most common complication and even death have been reported with major liposuction procedures done under general anesthesia. There has never been a single major complication when liposuction was done under local anesthesia. Local anesthesia can be used for smaller liposuction while spinal anesthesia and general anesthesia can be used for larger sessions. Do not press your surgeon to perform megaliposuction as the risks increase substantially when the total fat suctioned out exceeds eight liters.
According to the statistics released by the Florida board of medicine, office based cosmetic surgery procedures carry ten times the risks of death than procedures done in a same day surgery center with proper back up of an anesthesiologist. Another safety measure we follow is to refuse to do certain procedures such as tummy tuck, facelifts and breast lifts on smokers because the risk of skin sloughing and infection is greater.
To minimize the risks of infections we operate in a surgical hospital. Below is a discription of surgical hospitals.
How should you choose the right hospital for your cosmetic surgery?
The community hospital is the department store of healthcare, the jack of all trades. But it is a model with limitations, the limitations of the generalist. In the complex world of healthcare delivery, it is impossible for the generalist to be superior in every aspect. In the delivery of surgical services, for example, a traditional role for general hospitals, the specialist argument is a compelling one.
Emirates Hospital in Dubai and Abu Dhabi, where many CosmeSurge® operations are performed, does not admit patients for chronic illnesses, renal dialysis, cancer radiation therapy, brain surgery, open heart surgery, deliver babies or treat victims of car accidents or those who need prolonged rehabilitation. These conditions are best served at a general hospital. This separation allows for the Emirates Hospital, a surgical hospital, to focus on elective surgery performed on otherwise healthy patients thereby having less infections and faster recovery in a friendly atmosphere.
Specialty surgical hospitals have lower rates of nosocomial infection, infections that originate or occur in a hospital setting. They are usually very hard to treat as they are resistant to antibiotics. According to a December 2002 report from the Centers for Disease Control, the national rate in traditional general hospitals is 5.7 percent. The nosocomial infection rate is approximately two-tenths of one percent in specialty surgical hospitals.
A major reason for the lower rate of infection is that specialty surgical hospitals focus on elective and pre-planned surgeries. Infection rates in specialty surgical hospitals are lower because they don't perform surgery on "someone who is throwing up or bleeding or presenting with possible infectious conditions. I think that the otherwise healthy patient needs a place to go where nosocomial infection rates are less than 1 percent instead of 5 percent or more."
What are the most common side effects?
The most common side effect is bruising and swelling and pain after surgery, all of which are minimized by through the use of local anesthesia as it constricts blood vessel and lessens intra-operative bleeding.
How major are the operations?
It is often believed that aesthetic plastic operations fall under minor surgery. It is assumed that face lifting, for example, merely involves excising a bit of skin and then it is all over. This is basically true- but a carefully performed face lift takes a few hours and if not done right can end up with facial paralysis form nerve damage, bad looking scars or pulled down ear due to excessive skin resection. The surgeries that require the most skills by the surgeon are nose reshaping, facelifts, lower eyelid surgery, deep chemical peels and breast reduction. Even though the trend in plastic surgery is toward outpatient operations, many operations are still carried out on an inpatient basis. However, the hospital stay is becoming increasingly shorter.
Is it all just magic?
Aesthetic plastic surgery is commonly glorified as being "magic." This prejudice must be rejected categorically. As in all other fields of surgery, fundamental surgical principles also apply here and failure to observe them has consequences which would become immediately apparent to everyone.
Will there be scars?
As yet there is still no magic wand to produce surgery without scars. We take every care to place our incisions where they are not easily visible, for example in concealed sites of the body wherever possible. Fine suture material and special suturing techniques usually result in the scars being very inconspicuous. Although existing scars can be considerably improved, they cannot be entirely removed. One in a hundred patients may get excessive scarring (Keloid) which can be hard to treat. Keloids are more common in black skin.
Is aesthetic surgery just for women?
Due to the higher proportional of trauma cases, men are more often the patients in general plastic surgery, while in aesthetic plastic surgery on the other hand the percentage of women is much higher. Recently, however, the number of male patients in the latter category is rapidly growing.
Is it "luxury medicine"?
Aesthetic plastic surgery is very often described as luxury medicine and we are accused of operating only on those from the upper class and prominent people. This is simply not true. The majority of our patients are people like you and me, sometimes having to struggle hard to save the money or take out a loan in order to fulfill their heartfelt desire. And in each case the operation is carried out absolutely identically, regardless of whether a prima Donna or a housewife is lying on the operating table. Surgeons will always do their best for every patient who places trust in them.
Are there any age limits?
The subject of age limits for aesthetic operations is brought up time and again. The earliest aesthetic operations are already performed for prominent ears at the age of 5-6 years. Here surgeons hold different views as to whether the child itself should want the correction done or whether the parents' desire is enough.
Each person is unique and for this reason the question concerning the upper age limit should be answered individually. The precondition is always a generally good state of health.
Should you believe everything the adverts say?
This question is important since various private clinics have started calling themselves institutes, academy or use the word international. Doctors have at times been advertising using before and after photos that are not even theirs or are exceptional results that they cannot consistently duplicate. Sensational newspaper articles centered on a doctor with a cult-like status and creating the impression that everything seems possible and easy should be taken with a pinch of salt. My answer to this question is a clear "No."
Should the surgeon conduct a personal consultation with prospective patients before they undergo surgery? Do I ever recommend that surgery is not the right option? If so, when would this be the case? We have several full time plastic surgeons that see every patient before surgery. We evaluate every patient to assess their expectations. Unless their expectations are realistic and their underlying problem can be significantly improved with surgery, I do turn them down. The most common complication in cosmetic surgery in the USA is unmet patients’ expectations (10%). In other countries it is even higher because patients are less educated about their options and about how to select the best surgeon or Center for their particular need and because patients are too embarrassed to complain to authorities or seek legal help regarding a bad outcome when it comes to breast surgery for example.
At CosmeSurge® we are careful with our patient selection, advice and recommendations and we so not over-promise our patients results that are unrealistic. We have a team of sub-specialits each concentrating on a different area of cosmetic procedures. Our surveys repeatedly and consistantly shows a patient satisfaction rate hovering between 96-98%, one of the highest in the industry.
Any post-surgery tips?
You might be well advised during your convalescence to have a lot of good reading material and avoid looking in the mirror. It is very common to feel a bit depressed or scared during the first week of recovery. Should this get out of control call our center and we will hook you up with a patient of ours who had the same experience but was very happy few weeks later. Keep in mind that women are very jealous creatures. They will more than likely resent your transformation if they can't afford to do it themselves. My advice in this instance is to consider the source and do your best to rise above their pettiness. If it all gets too much for you always remember: nothing gives you a lift like a bit of Botox®.