Go ahead; admit it. You’ve thought about having some work done. A nip here. A tuck there. A little more here; a little less there. If you do opt for a cosmetic procedure, you will join over 10 million of your fellow Americans who had such procedures in 2005. This number represents an increase of 11 percent over the previous year and a startling 38 percent increase since 2000. With more and more people choosing to improve their appearance by means more ambitious than the judicious use of makeup or a new hairstyle, it’s important to understand the practice, procedures and possibilities of cosmetic surgery and cosmetic procedures.

As early as 600 BC, a Hindu surgeon reconstructed a nose using a piece of cheek, but the term “plastic surgery” didn’t come into common usage until the late 18^th century as a label for surgical procedures to repair facial deformities. The term actually has nothing to do with plastic but comes from the Greek word “plastikos” meaning “to mold or shape.” The first modern cosmetic rhinoplasty was done in 1923 and the first known facelift in 1931.

Generally speaking, if a surgery is done to improve the health of a person or the function of an organ, it is considered medically necessary and falls under the heading of plastic or reconstructive surgery. If the surgery is done primarily to improve the appearance of the patient, this is considered cosmetic surgery. The practice of cosmetic surgery, a subspecialty of plastic surgery, has come to include such nonsurgical procedures as Botox™ injections, microdermabrasian, laser hair removal, laser vein therapy, chemical peels and nonsurgical facial rejuvenation.

While plastic or reconstructive surgery is covered by most health insurance, cosmetic surgery rarely is. However, patients should consult with their own insurance professionals and with their physician to determine individual coverage.

Both Dr. George Poletes and Dr. Lee Colony are highly trained, highly skilled plastic surgeons who now specialize in cosmetic procedures and surgery and who, coincidentally, both established practices in the Lansing area in the late 1990s. They report that, like the United States as a whole, their own practices have seen increases every year in the number of people they evaluate and treat.

Dr. Poletes continues his work as a traditional plastic surgeon in his work with children, often done on a pro bono basis. He operates on a number of children with cleft lips and/or palates in this region and also travels to Mexico with the group Angel Notion to work with children there. He sees this as a “good balance” in his practice and finds satisfaction both in his work in reconstructive and in cosmetic surgery.

“As our population ages and the baby boomer generation enters their 50s and 60s, we are seeing them coming into our practice,” said Poletes.” They tell me that they don’t feel old, and they want to look as good as they feel. Sixty-five used to be old; it isn’t anymore. People are staying active longer, working longer, leading fuller lives. It’s human nature to want to look good; I don’t see it as vanity but rather as an understandable desire to like what you see when you look in the mirror. Looking better can make a people happier, give them more energy and make them more self-confident and feel better about themselves.”

He continued, “I’ve also seen an increase in the number of younger people looking to cosmetic procedures. They understand that starting early with preventive measures can lessen the need for more drastic procedures on down the line. We do a lot with nonsurgical intervention that can slow down the aging process. Many start with something as simple as Botox™ injections to improve the appearance of frown lines between the brows and on the upper third of the face. The injections are relatively painless, require no recovery time, and the visible results can last up to four months. Similarly, Restylane™, a dermal filler, is a nonsurgical, immediate and long-lasting correction which can be used on facial wrinkles and folds."

Dr. Poletes considers three things when he evaluates a patient’s suitability for surgery. It is important that the person be physically healthy, emotionally healthy and have realistic expectations for what can be accomplished. Spending time with potential patients going over their health histories, goals and expectations helps him make the decision as to whether or not he will proceed. He considers this evaluation process an essential part of the partnership he forges with each of his patients. He contends that “the art and skill is in the planning as much as in the actual treatment.”

In terms of trends in his practice, Poletes mentioned first the increase in numbers. With an increased acceptance of cosmetic surgery, people are more apt to consider it as an option than they have in the past. He also pointed to the increase in the number of male patients he sees. While the majority is women, more men are opting for cosmetic surgery or cosmetic procedures like Botox™. Another trend he has seen is the tremendous growth of nonsurgical procedures. Often, this less invasive treatment can produce the kind of dramatic results that the patient might have thought were only available through surgery. Poletes said that there have been “huge advances in medical skin care with a variety of procedures that are tremendously effective.”

Dr. Poletes also maintains a practice in Brighton.

Dr. Lee Colony served on the faculty of the Michigan State University Medical School from 1988 to 1996. Seeing the need for a freestanding surgical center for the practice of cosmetic surgery, he established his practice, Michigan Plastic Surgery, in 1996. (The facility is now shared by Dr. Rick Smith, but the two maintain separate practices.)  Procedures and surgeries offered by Dr. Colony are done on an out-patient basis in his own facility. With its own operating and recovery rooms, as well as a professional staff of healthcare providers, the facility provides the same high level of care as a hospital setting. In the same building, Michigan Skin Care, also established by Colony, offers procedures like Botox™ injections, micropeels, microdermabrasions and similar treatments.

Colony reported that the most commonly performed surgery in his practice is breast augmentation, followed closely by liposuction. This mirrors statistics throughout the country. The most often performed nonsurgical procedure is Botox™. (Interestingly, Botox™ is also used as a treatment for excessive sweating when injected into the palms of the hands or underarms.) According to Colony, “Botox™ can be used not just on the forehead; we also see good results in reducing crows’ feet around the eyes and fine lines on the upper and lower lips. We can also treat these areas with dermal filler, which tends to last a bit longer.”

He continued, “The treatments offered at Michigan Skin Care have good results, and we work with our patients to establish good skin care on their own using products and home medications that can’t be purchased over the counter. This preventive care forestalls the aging process and is increasingly sought by younger patients.

“Years ago, a patient had two choices—a facelift or nothing. Now we have many options, both surgical and nonsurgical. Together, we can make the right choices for the best results.”

Colony said, “We have seen an increase in patients who have had massive weight loss, usually as a result of gastric bypass or other surgery. They have lost the weight, but their skin has been stretched too much to recover on its own. We can remove this extra skin, do tummy tucks or lifts, and the results are dramatic.

“Gradually, we’ve been seeing more men in the practice. They usually choose liposuction or eyelid surgery.”

Asked about the prevalence on television of shows like Nip/Tuck, Dr. 90210 and Extreme Makeover, Colony said, “These shows are sensationalized, of course, but I think they have contributed to the knowledge about and interest in cosmetic procedures. Obviously, the stigma of cosmetic surgery is gone. Whether the shows themselves helped take some of the mystery out of cosmetic surgery or whether the new attitudes influenced the decisions to create these shows is pure conjecture.”

Poletes and Colony both emphasize that potential clients must make an informed and educated choice when it comes to a cosmetic surgeon. An MD or OD specifically trained in the intricacies of plastic surgery is the best option.

Both Poletes and Colony have websites which go into more detail on their own credentials and the surgeries and procedures they do.

Research; talk to people who’ve had it done; talk to people who decided not to have it done; educate yourself; talk to your doctor. Make the best decision for yourself.

In the book 100 Questions and Answers about Plastic Surgery, Diane Gerber said, “No one can or should tell you why you should consider plastic surgery for aesthetic reasons. You should be able to clearly define your desire to improve aging or to enhance facial or body appearance. Others may support you in your decision, but the decision to have plastic surgery should be yours alone.”