Plastic surgeons provide a fine-looking model of success at gathering

At their annual convention, plastic surgeons provide a fine-looking model for success.

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By Paul Farhi
Washington Post Staff Writer
Monday, April 26, 2010

The first thing you notice at a convention of plastic surgeons is how attractive everyone is, or at least looks. These doctors -- most are men, but there are a few women, too -- are walking advertisements for their own profession. Well-dressed and impeccably groomed, they have a certain glow. Some of them will tell you: They've had a little work done themselves. Either way, these surgeons cut fine figures, so to speak.

The barons of Botox, the lords of liposuction, some 2,000 strong, have been meeting for the past few days at the cavernous Gaylord Hotel in Prince George's County. The annual convention of the American Society for Aesthetic Plastic Surgery (ASAPS) is a busy affair, with seminars and symposia threaded like sutures throughout the hotel's many meeting rooms. There's a thrumming exhibit hall, too, with companies like Breast Oasis Inc. and Vein Gogh showing off surgical tools, saline implants and scar ointment. Some of the booths feature gory surgery videos on permanent loop.

The various panels address the latest advances in blepharoplasties (eyelid surgery) and otoplasties (ear jobs), but there's a lot of talk about how-to business issues and financial management, too. In that sense, the plastic surgeons are no different than any other professional group that meets once a year to ponder the eternal question: How do we make more money?

Right now, the surgeons will tell you, business is pretty good and getting better. Everything sagged during the recession; not everyone had $7,000 for a facelift, and those who did held off, feeling kind of sheepish about walking around with a new face or a suddenly perky body part when times were so tough for everyone.

"It's fair to say that plastic surgery is a leading economic indicator and the consumer is back," said Rollin Daniel, a cheerful surgeon from Newport Beach, Calif., in the body-beautiful center of Orange County. Daniel says his practice is about 20 percent ahead of where it was at this time last year. "Half of it," he estimates, "is consumers feeling better about their economic situation and half is pent-up demand."

Ask Daniel about the hot thing in plastic surgery these days and he has a ready answer: "Injectables!" That is, collagen and Botox and plastic dermal "fillers" that are relatively low in cost, have no surgical risk and require almost no recovery time.

As you imagine, the members of ASAPS do more than alter faces and bosoms. The beautiful thing about the $10 billion-a-year "aesthetic" plastic surgery business -- "aesthetic" being anything that has no actual medical necessity -- is that the number of procedures, and the ways to perform them, keeps growing and improving. Spend 10 minutes at the ASAPS convention and you'll learn that virtually any part of your body that you don't like can be altered by a knife, a silicone implant, a laser, a needle or some scary-sounding chemicals (hyaluronic acid, anyone?). Anything can be lifted (arms, neck, ears, eyelids, brows, breasts, etc.) or "augmented" (cheeks, chins, calves, breasts). You can take fat out (via liposuction) or put it back in (via injection). There are a variety of surgical procedures designed to "rejuvenate" a lady's, um, private parts, too.

The reshaping of the posterior is a thriving sub-specialty unto itself. Suffice to say, there are a number of ways to add to, subtract from or "re-contour" one's behind. A technique called "fat grafting" involves sucking fat from one part of the body (usually the thighs and abdomen), filtering it in a centrifuge, and then injecting it back there. The results depend on the artistry of the surgeon and the whim of the patient. Renato Saltz, a Salt Lake City surgeon and ASAPS president, says his clients often bring him photographs of celebrity derrieres and ask him for a replica; Jennifer Lopez and Beyoncé are popular models.

In any case, there's always something more to know. Daniel stopped to talk a reporter just as several of his fellow surgeons were emerging from a series of cadaver workshops. Cadaver workshops are exactly what they sound like -- hands-on tutorials involving a corpse.

Over in the Chesapeake Room of the hotel, a team of doctors wearing rubber gloves and spatter slickers had been attending a cadaver workshop titled "Facial Rejuvenation by MACS Lift" (a modified, less invasive facelift). Down the hall, there was another session titled "The Complete Basic Steps of Rhinoplasty" (nose jobs). It makes you wonder: Did the corpse have this in mind when he willed his body to medical science? And if so, will the dead guy look better "after" than "before"?

A few days at the conference can dispel a number of myths about plastic surgery and plastic surgeons. Although most of the aesthetic surgeons in America are men (94 percent) and most of the patients (about 90 percent) are women, men are a growing source of business. The organization says the most popular cosmetic surgeries for men last year were lipoplasty (liposuction), rhinoplasty, eyelid surgery and gynecomastia, or breast-reduction.

Teenagers are also getting into cosmetic surgery, though not as often as media reports tend to suggest (in 2009, only 2,953 breast-augmentation procedures were performed on girls 18 and under, less than 1 percent of the total, and a third of these were to correct congenital deformities, ASAPS says).

Another thing is, it's not just Americans who are obsessed with looking more "beautiful," a word that gets thrown around a lot at the convention. America remains the world leader in plastic surgery techniques, products and technologies -- U-S-A! U-S-A! -- but other countries are coming up fast. Brazil, for example, is an emerging world leader in cosmetic surgical innovation and in the number of procedures performed each year; hence the large contingent of Brazilian surgeons attending the conference. Companies based in Israel are among the leaders in cosmetic-laser technology.

In addition to attending medical school for four years, cosmetic surgeons spend between five and seven years in residency, a longer period than orthopedic or general surgeons. Sure, the rewards of aesthetic surgery can be great -- a busy sole practitioner can gross $3 million or more a year -- but the philosophical question is: Is making someone's nose smaller or breasts larger really the most socially beneficial use of all that knowledge and training?

Some of the surgeons at the conference had a ready answer: Cosmetic surgery isn't just about indulging a patient's vanity, it's about improving self-esteem. "Our patients say, 'I feel so much better about myself after surgery,' " says Thomas Francel, the chief of plastic surgery at St. John's Mercy Medical Center in St. Louis. " 'I feel more confident. I feel better about myself, my work, my relationships.' It's a perception question. . . . The perception can become reality."

But doesn't the "aesthetic" surgery industry simply feed women some unrealistic notions about female beauty, thereby justifying the need for "aesthetic" surgery in the first place? A quick look around the convention might tell you that. The models depicted in the oversize photos on the exhibit floor all look about the same -- young, white, thin, robust of bust. ASAPS itself uses the legendarily beautiful ancient Egyptian queen Nefertiti in its logo and calls itself "the leading authority on the science of beauty."

So, who sets these "aesthetic" standards, anyway, and who determines "beauty"? Who says a face tightened with a chin lift is more visually pleasing than a naturally jowly smile? Who says a proudly middle-aged face with a few sags and wrinkles is inherently less "aesthetic" than an unnaturally youthful and immovable Joker mug that has been trussed up like a pork loin? (Have we mentioned Joan Rivers yet?)

The answer, says Renato Saltz, is that "the marketplace decides," not the plastic surgery industry. The consumer is king (or mostly, queen)! "The media has a lot to do with it," he says. "People see things on TV or in the movies or in magazines, and they come to us and say, 'I want to look like that.' "

The "standards" aren't rigid, either; they're constantly evolving, like fashion, he says. "When I used to do tummy tucks a few years ago, I would leave a little fat. Now? No, they don't want any fat. They want it to be flat and hard." Globalization, too, is blurring national norms and perceptions: "Turks want Christie Brinkley's nose," Saltz says; Asians want to look more Western.

"We learn to be psychologists," Saltz says. "Some people have crazy expectations. You have to say no. I've been at this for 20 years. I can identify the red flags."

Saltz reaches down into a luggage bag and pulls up his laptop. "Let me show you something," he says. He punches up a series of slides he uses in his talks to other doctors. In the first slide, Mona Lisa's portrait stares back, her smile serene and enigmatic as always. In the next, her face and body are comically transformed by surgical and cosmetic means, with widened eyes, blond-streaked hair and collagen-thickened lips. Leonardo da Vinci's immortal image now sports a Jolie-like "trout pout" and breasts that float over the top of her blouse like unmoored dirigibles.

Saltz laughs. It's a joke, of course.

And then again, maybe it isn't.

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