the numbers increasing each
year. Procedures such as hair
plugs for baldness are catching
on rapidly each year as well.
Plastic surgery is no longer the
exclusive — or desperate
perogative of aging movie stars
or bored socialites who can leave
the country for six months to
recuperate, and magically
reappear smooth, taut, rested
and transformed.
Many people who seek these
procedures today are hard
working and responsible and
cannot spend several weeks
"hiding out" to recuperate.
Furthermore, the typical cosmetic
surgery patient today is often
quite candid about having the
work done. In a gesture of
bringing a bit of California lifestyle
to conservative Michigan
territory, one well known local
journalist came to lunch at a
popular Birmingham restaurant
recently with her sutures still in
place from a recent facelift.
"Our ideal patients" according
to Louis Argenta, M.D. interim
head of the section of Plastic
Surgery at U-M Hospitals, "are
somewhere between age 40 and
50, happily married, and
generally happy with themselves.
They are not movie stars, and
most are not radical or extreme in
their expectations. They are not
looking for surgical miracles to
please their spouses or to bring
them success in their careers,
and we tend to shy away from
taking on a patient who has
recently undergone a traumatic
event such as a death or divorce.
Basically they are 'regular folks'
who want just a little bit more."
The list of reasons goes on.
There is a premium in our society
on looking younger. Many of the
prospective patients who seek "a
little bit more" are people who are
meeting the public each day and
who need the impact of a good
first impression for their work.
Most important is simply a
change in values and attitude.
"No one NEEDS a face lift in the
most traditional sense," says Dr.

Argenta, "but I remember the
attitudes of my parents'
generation towards exercise
that if you worked all day, you
didn't have to go to a gym to work
out. That notion has changed,
and so have the reactions to
cosmetic surgery."
Most medical insurance
carriers reflect the attitude of Dr.
Argenta's parents — that
cosmetic surgery for purely
aesthetic reasons is not

T eenagers and

women in their 20's
and 30's have a lot of
surgery, but middle-
aged women have the
most surgery of all
age groups.

reimbursable through medical
insurance plans. But as the most
commonly requested operations
spread in popularity and lose their
elitist image, the fees are
becoming more affordable, the
techniques are becoming more
reliable and streamlined, and the
numbers of surgeons to perform
them are more readily available.
Today's most commonly
requested cosmetic surgery is
the blepharoplasty or eye lift. It
runs between $1500 to $3000.
Next are full face lifts, at $2500 to
$7000, rhinoplasty or nose bobs
at about $200 to $5000, and
mammoplasty or breast
augmentations at $1500 to
$3000. Augmentations are the
fastest growing procedure in
numbers with about 1 million
women who have had this
procedure in the United States.
The exceptions here are breast
reconstruction after cancer
surgery, and breast reduction
surgery. Both of these
procedures are reimbursable on
most medical plans, with
reductions usually specifying that
500 grams or more of tissue is

removed. University Hospital in
Ann Arbor performed 250
post-cancer breast
reconstructions in 1985.
"Techniques and instruments
are so much better now," says
Donald Kapetansky, M.D.,
chairman of plastic surgery at
Sinai Hospital who has been a
"pioneer," working in the field
since the earliest beginnings 25
years ago.
"Our anesthesia procedures
are much safer than when I first
started, and this enables us to do
many of these procedures on an
outpatient basis with minimal risk.
Breast reductions don't routinely
need blood transfusions
anymore, which many people
worry about, as we see girls as
young as 16 coming for this
procedure," Dr. Kapetansky
adds.
Though a breast reduction is a
major operation and usually
takes about four hours to do, Dr.
Kapetansky believes that this is
an important operation
psychologically. "Some girls
have an impossible situation, for
dating, or even participating in
sports," he says.
"We will wait until a young girl is
a bit older to do a breast
augmentation, with 18 being
about the youngest, and we have
found no correlation to the use of
silicone implants and causation
of breast cancer. But the
procedure is only 25 years old, no
one has lived with it for 50 to 60
years, though we have had
women successfully nurse their
babies after the surgery without
any loss of contour," Dr.
Kapetansky points out.
The price of coupling high
technology with asthetic
refinement is steep. Plastic
surgery residencies take two
years of specialized plastic
surgery training in addition to the
five to seven years of a traditional
general surgery residency.
Sinai's plastic surgery
department is one of just three
training programs in

Continued on Page 64

March 1987

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