Edward Jonas Domanskis, M.D.

That is no longer the question; close to two million people had cosmetic surgery this past year, according to the statistics compiled by the American Society of Plastic Surgery. Another seven million had other non-surgical cosmetic procedures. The total of close to nine million reflects a 33% increase in just one year. Not only has the number dramatically increased, but the demographics have also changed. No longer is cosmetic surgery for women, the old or deformed. Increasingly, men, even teens and those with minor imperfections go under the knife for beauty's sake!

There may be several reasons for this phenomenon besides the reality television shows. Although beauty is an age-old quest, present culture has placed an extreme emphasis on appearance. One needs only to glance through any magazine or watch any movie. The stigma of cosmetic surgery has gone-the majority of patient's talk freely about their surgery or wanting and anticipating it! To look your best by whatever means possible has not only become acceptable, but actually desirable.

Hollywood and the rich are on their umpteenth nip and tuck, while your neighbor, co-worker and even teen next door are undergoing liposuction, breast enlargements and facial rejuvenation or extreme makeovers. They likely are financing their cosmetic surgery or paying with their credit cards.

The art and field of plastic cosmetic surgery has evolved with new and more effective procedures. Let us talk about some of these exciting techniques that have allowed plastic surgeons to keep the facial "clock turned back". These not only involve long-lasting surgical solutions, but also temporary ones.

One of the most common temporary solutions is BOTOX. This toxin is injected to paralyze the offending muscle, thus lessening the line it produces. The most common areas that it improves are the frown lines as well as the "crow's feet" area. On average, its effects last three to five months. Sometimes, though, it can prevent necessary movements like closing of the eyelids, which is, fortunately, temporary.

Once the facial lines are established, fillers to efface them are available. They are by-products of animals, humans or synthetics like COLLAGEN, FASCIAN, silicone (not approved by the FDA at this time), Restylane, Radience and the most recently approved Hylaform. The plethora of these products attests to their limited and transient effectiveness.

The crevices and depressions come next. One's own fat can be transferred to plump these visibly aging hollows. The fat must "attach" in the area placed. Presently, its growth and storage is only a desire for it is yet again a temporary, but helpful means of achieving a more youthful, fuller face. Complications are unusual and correctable and this procedure is easily repeatable.

Textural skin changes, primarily due to sun damage, require different solutions. Creams, lotions and potions have all been used with limited effectiveness. Products that have broken down the impenetrable skin layer have faired the best. Again, the list is long and includes acids in various dilutions, abrasive chemicals, scrubs, and dermabrasion, but most have been replaced by the laser. This has provided the plastic surgeon with a new, more precise and effective tool that, at its best, dramatically erases unwanted lines and reverses aging and sun damaged skin at any age.

The more effective lasers work by actually burning the skin. The deeper the laser penetrates, the longer and more unpleasant is the recovery, but more significant and longer lasting is the improvement. Scarring and pigment changes can occur. Other less invasive procedures like IPL (light laser), Thermage (radiofrequency) are gaining in popularity but still lacking in effect. There is some initial skin tightening which usually does not last. For, this requires real surgery! In some cases though, not so extensive surgery can yield not so subtle changes.

The most recent significant advance in facial cosmetic surgery is primarily because of the endoscope. The endoscope is a hollow, rigid tube, into which is incorporated a strong light and camera which transmits magnified images to a video screen. This has allowed almost scar-less cosmetic surgery.

The plastic surgeon inserts specialized instruments through small one-inch access incisions hidden in the hair and guides them, not by direct visualization, but, indirectly, by what he sees on the video screen. Through these small cuts (Minicision lift), repositioning of the deep soft tissues of the face takes place. These tissues of the face are re-suspended upwards, exactly the reverse of their descent, rather than in a front to back direction like a traditional facelift. But, it does not replace the traditional facelift, for no skin can be removed with this minimally invasive surgery.

When excess skin is already present, forming jowls or looseness of the face and neck, then it is time for a traditional facelift with its attendant scars and recovery. Advances have been made in this area also that may shorten the length of the cuts and prolong the rejuvenating effects.

My personal techniques have evolved over many years. It has been that length of time since I have done an ear-to-ear traditional forehead lift and I anticipate the day when cutting and the resultant scars will become a thing of the past! For, plastic surgery will continue to evolve and keep pace with the demands of the ever growing and aging population striving to look better and younger.

I hope this overview has provided you with further insights into my exciting and dynamic field of plastic cosmetic surgery!

Dr. Edward Jonas Domanskis is certified by the American Board of Plastic Surgery and is a member of the American Society of Plastic Surgery and the American Society of Aesthetic Plastic Surgery. He is an Assistant Clinical Professor of Surgery(Plastic)WOC at University of California(Irvine). Recognized as Orange County Physician of Excellence in Plastic Surgery for 2005 as well as America's Top Physicians. He is in private practice and limited to cosmetic surgery. His office is in Newport Beach,California. Dr. Domanskis appears regularly on numerous television programs including the Today Show, Good Morning America, 48HRS, Inside Edition, EXTRA ,Discovery and print media world-wide including the Los Angeles Times, Family Circle, London Times, Wall Street Journal among others. You may reach him through his web site http://www.surgery-plastic.com/ or office at (949)640-6324 or 1-888-234-5080.