Limits of Cosmetic or Facial Reconstruction

By Bill Kray

Cosmetic surgery is generally undertaken to make someone appear more youthful or attractive. This differs from reconstructive surgery, having the goal of correcting anatomical irregularities. Hence, separating conjoined twins (when practical) or removing extra appendages are considered reconstructive—often medically necessary. Disfiguring violent acts such as animal bites, acid or heat burns may also require a series reconstructive surgeries.

Sometimes the end result can only be appreciated when compared to the initial damage. Absence of an eye, nose or mouth seriously impacts the quality of life. The goal might be to restore basic senses or the ability to speak. Following skin grafts and transplants, scaring and asymmetry may still be apparent. Lifelong micro-improvements can be achieved with an unlimited medical budget. But for most people, there's a limit to medical insurance, personal resources and physician philanthropy.

Severely Disfigured

Carolyn Thomas was the victim of an eight-year abusive relationship that ended tragically with the death of her mother and her own face being shot off by her boyfriend. Against all odds, Carolyn survived to tell her story. The gunshot removed her right eye, her nose and most of her mouth.

 Before and after reconstructive surgery for Carolyn Thomas

Before and after reconstructive surgery for Carolyn Thomas

As with other severely disfigured patients, Carolyn's "after" picture may seem more like a "before" picture. The goal may be to restore basic senses or the ability to speak. In this respect, it has been a success. With sunglasses and cosmetics, she now blends in better with the general public. In fact, Carolyn shared her story on the Oprah show. When setting expectations, focus on functionality for such reconstruction.

Beautification Surgeries

“A group of surgical procedures that alter the face to increase its femininity” is called facial feminization surgery (FFS) or gender confirming facial surgery. Results can be dramatic and life-changing. However, beware if you plan on later marrying and having children. A husband in China sued his cosmetically enhanced wife over the undesirable appearance of their offspring. In the suit Feng Jian described his daughter as “ugly beyond description” and was awarded $120,000 for marriage under false pretenses.

 Before and after FFS patient of Jeffery Spiegel, MD

Before and after FFS patient of Jeffery Spiegel, MD

Whether with fillers or scalpels, patients who get facial cosmetic surgery often assume that they will appear dramatically younger and more appealing. As with all surgeries, a risk of adverse reactions or even death is a possibility. But even when things go quite well, the improvement may not dial back decades of aging. A study of 120,000 facelifts, published online in JAMA Facial Plastic Surgery in 2013 found that patients judged by independent viewers looked only three years younger, on average. An article in The New York Times provides the following rationale.

The very nature of what we consider “old” today also played a role in the results, said Nancy Etcoff, a psychologist at Harvard Medical School and the author of “Survival of the Prettiest: The Science of Beauty.” This study looked only at surgical results, and didn’t use laser resurfacing to address brown splotches and or fat injections to add volume. But a loss of plumpness in a face reads old, as do wrinkles or age spots, she said.

Skin tightness, plumpness (collagen), age spots, and blemishes all contribute to the perception of age. Correcting one or more while leaving the others unchanged sends mixed messages to the viewer. This not only alters the perceived age but signals that plastic surgery may have been involved.

Cosmetic surgery designed to straighten a crooked nose, improve droopy eyes or reduce the size of breasts causing backaches can make the patients feel about themselves if performed by a qualified professional. But don't expect to find the fountain of youth on the sharp end of a blade. Be realistic with your expectations.

Bill Kray

Los Angeles, United States

Vegetarian health advocate, graphic designer, illustrator, programmer and prolific blog writer.

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