- The Washington Times - Tuesday, December 9, 2003

The wallet-sized box underneath Jackie’s Christmas tree in Altadena, Calif., wasn’t a wallet. Nor was it jewelry. Instead, the gift-wrapped box held a handwritten note from her husband asking, “What better present can you give someone than helping them feel better about themselves?”

Jackie’s gift wasn’t diamonds, but a face-lift performed by Dr. Richard Fleming at the Beverly Hills Institute of Aesthetic and Reconstructive Surgery.

Christmas is the busiest time of the year for plastic surgeons as people schedule surgeries to look good for the seasonal festivities or simply because the holidays offer a convenient recuperation time from a face-lift, nose job or breast implants.

The number of Americans undergoing both surgical and nonsurgical cosmetic procedures has skyrocketed in the past six years.

The American Society for Aesthetic Plastic Surgery (ASAPS) prohibits cosmetic surgery to be awarded as a raffle item, charitable donation or promotion. As a result, most board-certified surgeons also shy away from issuing Christmas gift certificates. But Dr. Fleming says family members arrange to give surgical gifts for the holidays.

“Christmas gifts [of plastic surgery] are very, very common,” the California surgeon says. “It’s been going on for a long time.”

Dr. Robert K. Sigal, a staff surgeon at the Austin-Weston Center for Cosmetic Surgery in Reston, says his clinic does not issue gift certificates, but he does see couples come in together and it is clear that a gift mentality is involved.

“He gets the car; she gets the face,” he says.

The trend has not reached all clinics.

“I’ve had lots of couples come in over the years and say the surgery per se was a gift from someone else, but it wasn’t necessarily a Christmas gift,” says Dr. Robert W. Bernard, who operates from a clinic in White Plains, N.Y., and is the president of ASAPS.

Dr. Mark Sultan, chief of plastic surgery for Beth Israel Medical Center in Manhattan, says he is not aware of any surgery as a gift and he discourages the practice.

“It changes the doctor-patient relationship,” Dr. Sultan says. “It makes it less medical and more social almost. … Plastic surgery, when you cut through all of the fluff, is still a serious situation. It’s still incisions and weighing benefits and risks.”

Although Dr. Bernard says he has no qualms with the idea of surgery as a gift, he cautions that the social environment must be right.

“I think it’s very hard to give a generic $500 gift certificate toward a cosmetic procedure — whether that procedure is collagen or botox or toward a face-lift — from one person to another because that person may not have wanted something to begin with,” he says. “So the giver has to know the receiver.”

Dr. Bernard has seen parents bring in their teenagers for nose jobs or spouses demanding face work for uninterested recipients, although such circumstances are rare.

Before cosmetic surgery is performed, the patient must undergo an interview with the surgeon, as the doctor tries to assess motivation and expectations. Realistic expectations are necessary for any successful surgery, doctors say.

“I think the biggest pitfall [for plastic surgery] is a person with unrealistic expectations that goes unrecognized prior to surgery by the person and the plastic surgeon,” Dr. Sigal says. “Expectations that aren’t just possible. Like, ‘If he did a better job, I would be married now.’ Or, ‘If my breasts were just a little big bigger, I would have my promotion.’ Kind of goofy stuff that is unspoken but is just unrealistic.”

Whatever the expectations, plastic surgery has become increasingly popular. ASAPS reports that the number of liposuction procedures performed annually in the United States more than doubled from 1997 to 2002, from 176,863 to 372,831. The annual number of breast-implant procedures increased from 101,176 to 249,641 in the same period.

The biggest increase in cosmetic procedures, at 2,446 percent, was botox injections, which went from about 65,000 in 1997 to 1.65 million in 2002, ASAPS reports.

The popularity of TV shows focusing on plastic surgery — ABC’s “Extreme Makeover,” FX’s “Nip and Tuck” and TLC’s “A Personal Story” — also reflect great public interest and acceptance of such procedures.

“There has been a definite shift in the way our society perceives plastic surgery,” Dr. Sigal says. “It is way more mainstream.”

Plastic surgeons attribute this trend to several factors, such as the development of more efficient procedures, growing public awareness and the aging of baby boomers, an affluent clientele facing a job market that values youth and vitality.

“Women become invisible when they hit 50,” Dr. Sigal says. “For women who have sort of used their femininity and beauty in constructive ways throughout their lives, to have that sort of go is just remarkably deflating.”

Although media coverage has helped popularize cosmetic treatment, surgeons say this can prove problematic.

“I think most of us in the field are a little dismayed with what’s happening in the media in terms of cheapening the importance of plastic surgery,” Dr. Sultan says. “There’s a counterculture to this extreme makeover. … There’s just a lot of hype out there about how easy plastic surgery is. You walk in, and you emerge 10 minutes later with a new face and a new life. It’s just not like that. Reality is quite different.”

Because of the prevalence of breast implants among models — including those in magazines such as Playboy — some men and women now “think breasts are supposed to look like implanted breasts,” Dr. Sigal says. “They don’t know what natural breasts look like anymore. They want to have kind of a shelf.”

For those who know what they want out of surgery, who are doing it for themselves and have realistic expectations, cosmetic surgery can silence that little voice that says, “Your nose has a bump.”

“A gift is not something that is necessary, but it something that is important, a good gift,” Dr. Sigal says. “It makes a difference and fills a hole in your life. Cosmetic surgery really does all of those things.”

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