TOWN & COUNTRY'S
1999 COMPREHENSIVE
GUIDE TO COSMETIC SURGERY

Whether you're considering a little cosmetic tweaking or a complex surgical procedure, your challenge is the same: to determine which specialist will do the best job and to carefully evaluate the doctor's credentials. It's a complicated task. These days, plastic surgeons aren't the only ones performing cosmetic surgery. As managed care threatens specialists' incomes, these doctors are increasingly gravitating toward the practice of cosmetic surgery, which is for the most part not covered by insurance (some reconstructive surgery is covered). Patients pay out of pocket, and pay a lot - making this one of the last bastions of free enterprise in medicine. The fierce competition for your business means it's imperative that you know how to cut through the hype.

Your first step is to find the right cosmetic surgeon for you. Many people overlook a reliable source of information: their regular doctor. Whether this is an internist, family doctor or gynecologist, he or she should be able to steer you to several candidates. If you already have names, "Run them by your doctor," says Richard Glogau, M.D., clinical professor of dermatology at the University of California, San Francisco. "Your physician might bring up your thyroid or heart condition, things a plastic surgeon should know about. Don't be afraid your doctor is going to disapprove. He or she will be thrilled you thought to ask." This is also a good time to get involved in the selection of your anesthesiologist. Dr. Gloau says: "Ask your doctor, 'Who is your best anesthesiologist, and will you make sure he is available for my procedure?'" In many practices, the anesthesiologist calls patients the night before surgery to answer questions.

Although it's not common, some women who have Botox injections in their foreheads end up with ptosis, or droopy eyelids, which can impair vision. Now they don't have to live with the side effect for several weeks until the Botox wears off. San Francisco dermatologist Richard Glogau and his colleagues have found that the problem can be corrected with iopidine eyedrops, which cause the muscles that raise the upper eyelids to contract. Ptosis occurs when too much Botox is injected into the muscles of the forehead or too close to the bony ridge above the eyes. The paralyzing solution then diffuses and stills the muscle that controls eyelid movement. Says Glogau: "The drops are an emergency approach, but they work."

Reinventing the Peel

A decade ago, few doctors would have peeled sun damaged facial skin. The only resurfacing options available then were caustic chemical processes or dermabrasion - risky and painful procedures, typically reserved for the most deeply lined or scar-ravaged complexions. Today, thanks to milder materials and methods that allow for extraordinary precision in removing paper-thin layers of the epidermis safely, chemical peels have become the most common cosmetic procedure performed in the United States, according to the American Society for Aesthetic Plastic Surgery.

Resurfacing owes its popularity, in large part, to the evolution of "superficial" chemical peels - now widely used to smooth fine wrinkles, correct pigment irregularities, soften scars, treat acne and reverse early signs of sun damage, including cellular changes that can lead to skin cancer. Superficial peels (aka epidermal peels) are medical procedures that afford lasting changes by stripping away living cells in the epidermis, setting in motion a healing process that generates a new surface. (These are not to be confused with "salon" or "lunchtime" peels, which temporarily smooth skin by exfoliating the thin, outermost layer of essentially lifeless cells, says San Francisco dermatologist Richard Glogau, M.D.

Since superficial peels work their restorative magic in the outer layers of the skin, they are particularly adept at eradicating all types of skin discolorations and textural abnormalities. They don't penetrate deeply enough to banish acne scars and/or wrinkles (usually treated with lasers, medium-depth or deep chemical peels or dermabrasion), but they can stimulate some cell growth in the dermis, smoothing out the skin's appearance, says Dr. Glogau.

Superficial peels vary in intensity depending on the strength of the chemical agent and the number of applications. The mildest ones - best for young skin, like Egan's - have an almost imperceptible initial effect and are generally done in a series to produce visible changes, costing between $100 and $200 per treatment. The more intense peels, which are optimal for mature or badly damaged skin, yield results after one or two sessions, but require several days of downtime due to redness, flaking and pinkness that may last for weeks (expect to pay up to $3,000 or more per treatment). Dermatologists caution that many factors can alter the strength of a peel. "Medications, skin-care products and pregnancy can magnify the effects of the resurfacing agent," warns Glogau, "so it's best to check with your doctor before any peel."