Is plastic surgery an art form?

It’s no secret that I am into art; I collect art, I make art, and it colors my approach to plastic surgery. So in a sense I consider plastic surgery an art form as much as a technical tour de force, but a new exhibit at a gallery in New York makes the point literally. Apexart, in the TriBeCa district, has a new show curated by a plastic surgeon featuring “before and after” images and surgery videos. The patients are the medium, the operating room the studio. I haven’t seen the show, but I understand that it covers a range of procedures from pediatric reconstructive cases to facelifts.

The concept is interesting, but I suppose it was just a matter of time. Superficially, it seems perfectly legitimate to consider plastic surgery an art form, and I will be the first to defend the idea. But it also begs the question of what art really is. Plastic surgeons have long debated whether what we do is more science or craft; I am of the opinion that it is both. The downside to a show like this is not that it sensationalizes plastic surgery, but that it may oversimplify the question of art’s importance in a broader sense.

I am reminded of the recent case of a private college whose endowment fund evaporated with the economic collapse last year. They were forced to consider selling the one thing that had retained its value over the years: their art collection. Art isn’t merely a luxury, and its value isn’t arbitrary; according to Denis Dutton, author of The Art Instinct, making art is in our genes. And just take a look around to confirm that self-adornment and self-enhancement are impulses just as ingrained. It’s not a question of whether these are natural and normal pursuits but where to draw the line between good and bad taste.

I have a suggestion for the bad taste side: Another new art show, this one at the Weisman Art Museum in Minnesota, features a petunia plant. Named “Edunia,” the plant has a copy of one of the artist’s genes spliced in, making it technically part human (he calls it a “planimal”). In this case, using biomedical technology to create a living “work of art” just seems meaningless to me. Sure, the idea is provocative, which is the probably the whole point, but so what?

So I’ll stick with figure drawing and working toward bringing out people’s natural beauty with plastic surgery. Oh and I am definitely all about the new technology too, but I think of it as a tool and not the statement in and of itself.

Happy 50th Barbie

Much has been made of the symbolism of the iconic Barbie doll, who I’m told turned 50 last month. (No plastic surgery needed because she is plastic; her ludicrously long legs and other features setting an unrealistic standard of beauty; and even the jokes from her celebrated dumping of Ken because he was anatomically incomplete to “divorcee Barbie” costing more because she comes with most of Ken’s stuff.) But some take seriously the question of what Barbie says about a society that creates such a preposterously proportioned plaything. Do girls, and women, really aspire to be like Barbie?

At least one person has, a plastic surgery “addict” named Cindy Jackson who was born the same year as Barbie and who has made it her goal in life to become a sort of human Barbie doll. The reported cost of this plastic surgery transformation is in the range of six figures. Has this made her happy? You will have to ask her.

Plastic surgeons have become more attuned over the years to the problems that can go with this sort of plastic surgery compulsion. Patients who have serial plastic surgery without ever being truly pleased with their appearance often have a condition called Body Dysmorphic Disorder, or BDD. Fortunately this is not common, and most people who show up in a plastic surgeon’s office have healthy motives. They just want their old body back after having kids, or a less tired look to match their true energy level. Plastic surgery to please someone else or to try and live up to perceived societal expectations is always a bad idea.

But the truth is that Barbie really is more likely to end up with a fancy sports car and a swanky Malibu home. Looks do matter. And there is a place for plastic surgery, somewhere between the extremes of trying to be the human Barbie doll and acceptance of whatever our genetics have in store for us, no matter how unattractive. (We could continue that line of reasoning to birth defects, which few would argue should not be repaired, but these are at the end of a continuum of conditions that include merely disproportionate noses or crooked teeth.) The psychological effects of plastic surgery have been studied quite a bit, and they are uniformly positive when it is done for the right reasons. Self-esteem is improved, along with a generally more favorable outlook, leading to better measures of functioning in daily life.

Ultimately, it isn’t all that complicated. Plastic surgery isn’t a substitute for the things you can do for yourself with diet and exercise, nor is it a cure-all for every disappointment in life. As a rule, people really don’t want to be Barbie, they just want a restored version of themselves. Oh and Barbie?-Your AARP card is in the mail.

Hydration theory all washed up?

There was a feature on the local TV news recently about some new anti-aging product – I don’t recall what it was, but there was some controversy about its effectiveness – and the anchor wrapped up by summarizing what we all take for granted about anti-aging behaviors: get enough sleep, exercise, and drink lots of water. That last piece of advice seems to be widely applied, judging from the number of people lugging water bottles around as though they are concerned about suddenly wandering out of damp Seattle and finding themselves in the Sahara. Does drinking lots of water really make us healthier, or are we just wet behind the ears?

Intuitive reasoning bears on this behavior. By making an effort to drink more water, we are flushing out the “toxins” that are so harmful, right? And our skin needs lots of water so that it will stay well-hydrated and youthful, so it seems like a no-brainer. But there is a disconnect here between intuition and clinical science. What, if anything, can be proven about this theory?

Some have suggested that dehydration is an inflammatory state, and we do know that inflammation is an important underlying process in premature aging. But even that conclusion is based on pretty scant data. And to take it a step further by recommending extra hydration (as opposed to adequate hydration) is a wholly unproven proposition. There just isn’t any research data to back it up, and I have looked. Further, the notion that we can convince out bodies to bypass all of the normal mechanisms that determine how much water to hold on to and put some of the excess into our skin, or flush out more toxins, is a theory that just doesn’t hold water. Our kidneys are smarter than that.

You may be saying, “Well, it makes sense anyway, and what can it hurt?” Other than having to schedule your day around proximity to lavatories, there actually is a potential downside. Even water can be harmful in excess, as tragically demonstrated by a woman who died trying to win a water-drinking contest from a local radio show last year. That is admittedly an extreme case, but it illustrates how it is a possible to throw a lot of things out of balance by not simply listening to your body and drinking when you are thirsty. Our bodies are pretty well fine-tuned to inform us when we need a drink. So drink enough water, just don’t go overboard.

Plastic surgery down but not out

The 2008 statistics were released this week from the American Society for Aesthetic Plastic Surgery (ASAPS), which represents board-certified plastic surgeons who devote most of their practice to aesthetic (cosmetic) surgery. It’s an annual ritual and the numbers are dissected every which way to see what they imply about trends in plastic surgery and society as a whole. The statistics also measure nonsurgical cosmetic procedures.
So what’s the big news this year? Surgical procedures overall were down for the first time, by about 15% overall, which isn’t any great surprise given the economic climate. What few expected though was that breast augmentation is now the number one surgical procedure, overtaking liposuction, which has held the number one spot since ASAPS first started collecting the data 12 years ago. One likely explanation for the rise of breast augmentation (more than 350,000 cases last year) relates to the FDA clearance of silicone implants a little over 2 years ago. Since they give more natural results for many women, there may have been a sort of pent-up demand, and some women unhappy with their saline implants may have been changing to silicone. In a broader sense though, there is just more comfort now that silicone is in fact safe and people just tired of hearing otherwise when the science gave the implants a clean bill of health years ago.
There is a bigger message in the statistics if you look back over the past few years. Even though plastic surgery has more than doubled since the turn of the millennium, nonsurgical procedures such as Botox and dermal fillers have increased some 750%. The rise of cosmetic medicine, and the inevitable decline of more invasive procedures will be the theme in coming years. Of course there is a long way to go before nonsurgical procedures can truly compete in terms of results, but there are compelling benefits if they can. For now, it is one big happy family since the medical procedures for the most part do what surgery can’t and vice-versa, but watch for big changes down the road.

Botox and mood: It's a good thing

Billy Crystal had a character he played on Saturday Night Live back in the day who used to say "If you look good, you feel good darling" or something like that. Turns out, it's true, and even something like Botox can help according to a study just out in the Journal of Cosmetic Dermatology. Doctors at the University of Cardiff, in the U.K., evaluated mood in 25 subjects who received Botox to the worry lines between the eyebrows. The patients showed significantly less negative mood by standard measures, as compared to a control group. Specifically, subjects were less irritable, depressed, and anxious. This has actually been studied before and these results confirm those earlier findings.
There is more to this than might appear at first glance. The authors of this study point out that facial muscles are not just involved in expressing emotion, they are involved in the experience of emotion as well. The muscles between the eyebrows (called "corrugators") convey concern, anger, and worry. By relaxing them with Botox, the experience of these emotions seems to be lessened through a sort of biofeedback loop. An interesting question is whether this is also related to the effect of Botox in lessening the frequency and severity of migraine headaches for a large number of people. In any case, there is something to smile about.

patterns

It's funny how things seem to appear in groups. this week we had one day that had several mother-daughter consults together, the next was everyone from Alaska, and we seem to have gone through more Botox in the last week than the whole previous month. Surgery this week is mostly tummy tucks (abdominoplasty), while next week seems to be facelift week. We certainly don't plan things this way but that's the way it often works out.
The mother-daughter thing is not what many assume; it is simply a matter of mutual support. Mothers may feel that it is time to do something for themselves after raising a family, while daughters are often dealing with the more recent changes from childbearing. Sometimes there are issues that the daughter was born with such as asymmetrical breasts, and the young woman is now old enough to consider correction. Those who may criticise and say that we would all be better off learning to accept our flaws should walk a mile in their shoes first. We are not dealing with vanity here.
I am tempted to interpret the surge in Botox and fillers (Restylane, Juvederm, Evolence) as a sign that the economy is improving, though there are few other signs offering such encouragement. In at least one or two cases, it is people competing with younger professionals in a more tenuous employment market. Perhaps other people are just getting tired of hearing about all the gloom and doom and just wanting to get on with their lives.

The buzz on caffeine (It’s good for you)

It may come as no surprise to coffee-fueled Seattleites, but the latest research from the University of Washington here has caffeine addicts buzzing. Turns out that caffeine is not only a health food, but perhaps the next exciting skin care ingredient, according to UW skin cancer expert Dr. Paul Ngheim. I have been following the caffeine story for a while, even including some interesting data about caffeine’s healthful properties in the first edition of Age Gets Better with Wine.

This latest research is based upon findings from the UW and Dr. Allan Conney at Rutgers University, which found that caffeine protected mice from the effects of ultraviolet radiation, a known trigger for skin cancer. But as with many such findings, it wasn’t where they expected the research path would lead. They started with an evaluation of tea extracts, assuming that the polyphenols-antioxidant molecules similar to those found in red wine-were the active ingredients. Tea is known to have great antioxidant properties, and polyphenols have been shown in a number of studies to confer protection against UV radiation. But when the decaffeinated version failed to work as well as the full octane type, attention focused on the caffeine, which when tested independently turned out to be the key. Coffee, by the way also has good levels of antioxidants, and both coffee and tea drinkers enjoy lower rates of cancer overall.

But the news gets even better for latte lovers. Another large study out this month from Harvard found that caffeine consumption-whether from coffee or tea-was associated with a lower risk of stroke, particularly for women. There are actually several studies with similar results published in recent years. And does anyone remember the cellulite creams that were so popular a decade ago? They did work (although they had to be applied 5 times a day) and the active ingredients were caffeine and similar compounds. Caffeine seems to shrink fat cells too.

So if you will excuse me, I am going to make a run to Starbucks. Can I get you anything?