What's with the attitude? Views on plastic surgery around the world

With Botox annual sales approaching $1 billion, and breast augmentation and liposuction in the hundreds of thousands of cases each year in the U.S., it would seem that people who haven’t had “a little work” done would be the exception. There are still those who don’t “approve” of plastic surgery, but annual surveys by the American Society for Aesthetic Plastic Surgery show attitudes are steadily becoming more positive. It’s not a uniquely American thing though; when I was in Argentina and Brazil a couple of years ago for an international plastic surgery conference, it was hard to escape the impression that the South Americans thought they invented plastic surgery. They did have a head start on the cosmetic surgery side of the specialty, and attitudes have always been more favorable there.
It’s becoming a worldwide phenomenon. Korea, of all places, has the highest number of plastic surgeons per capita of any country, and a survey in Russia found that about half would “consider plastic surgery.” Rhinoplasty specialists are known to do a thriving business in Iran, and Turkey is becoming a destination for cosmetic surgery. I am off to India for a plastic surgery conference this month, and plastic surgery is becoming popular there among those who can afford it. Interestingly, the Dutch and Norwegians remain staunchly against it.
Whatever your view, there is a good side to all this. The more it is out in the open, the more scrutiny will be brought to bear which in turn will foster improved techniques and standards. One downside is that now everyone wants to be a plastic surgeon – often without the years of specialty training.

Fat chance: Has the time for breast enlargement with fat injection arrived?

The annual meeting of the American Society of Plastic Surgeons (ASPS) is just about to wrap up here in Seattle. As a member of the Emerging Trends committee, I am involved in putting on the “hot topics” session, which always has a few zingers. I’ll be posting on some of those in the coming days, but the question of whether or not it is safe and effective to use one’s own fat for breast augmentation is front and center.
It’s a simple idea: why can’t we just take some fat out from the bottom, or the love handles, or some other area where it isn’t wanted, and use it to enlarge the breasts? Certainly, there can be no more natural means of breast enhancement. In recent years, techniques for fat grafting have improved a lot and they are being used to improve the results from breast reconstruction and some cases of implant augmentation, by smoothing out contours and irregularities. Why not just do it for the entire breast in the first place?
At the meeting there were a few reports of some success, but also a few cautionary notes. For one, the volumes used are low, with no more than a cup size or so of enlargement possible. Concerns about the grafts leaving lumps that interfere with mammograms seem to have been addressed, so that barrier is coming down. But a French surgeon reported some evidence from animal studies that it is theoretically possible that the grafted fat could stimulate breast cells, resulting in an unknown effect on the risk of breast cancer. There is no evidence of this in humans, but it is a sign that we should proceed cautiously. So stay tuned, but don’t expect every plastic surgeon to be offering the procedure in the immediate future.