from SUNDAYPAPER.COM, January 23 - 29

ATLANTA GOES PLASTIC

Our city's obsession with cosmetic surgery

It's always been difficult to turn on the TV or flip through a magazine without witnessing our obsession with appearances. The difference these days is that we're doing something about it: plastic surgery.

What's more, television programs like “Extreme Makeover” have turned this once private procedure into a public spectacle or, in the case of “The Swan,” an actual game show. Appearance-obsessive Web sites are innumerable - from hotornot.com, where you can judge whether or not a particular subject's attempt to make him or herself look attractive did the job (plastic surgeons advertise on the site). Our obsession reached an odd climax when speculation ran amok that Danny, the Pekinese crowned 2003 champion at the famed Crufts dog show in England, might have had a facelift. (Turns out he didn't.) Meantime, F/X has gone for the jugular, turning plastic surgery into an award-winning television series, “Nip/Tuck,” which, according to creator Ryan Murphy, is a “heavy drama about what people hate about themselves and why they hate themselves.”

PUBLIC ACCESS
Plastic surgery is nothing new. It first moved into public consciousness in the 1950s, just as President Harry Truman was pushing a national health care plan. With the medical profession in the news, the president of the American Society of Plastic and Reconstructive Surgeons, Leon Sutton, M.D., sensed an opportunity to give his chosen field of practice a public relations makeover and so called upon plastic surgeons to make concerted efforts to communicate with the public. Across the country, they appeared on the new medium called television to discuss the practice in the open. As the public grappled with the moral and social implications of plastic surgery, and comedians like Phyllis Diller appeared on television cracking jokes about it (“The only parts left of my original body are my elbows!”), the field made great technological advances. A new substance emerged called silicone. Although it was initially used to treat skin imperfections, a Houston doctor named Thomas Cronin created a sensation in 1962 when he used it as a breast implant device.

But why the recent fascination? Plastic surgery has always been the province of the rich and famous - but that was before Geraldo Rivera had the fat removed from his buttocks and injected between his eyebrows on national television in 1992. Since then, “having something done” has inched its way out of the shadows and into the spotlight, boasting a roster of icons (willing or not) from Jane Fonda to Courtney Love. Fundamentally, Hollywood's attitude has changed and so then has the public's. Julia Roberts and Jennifer Aniston recently told People magazine that they wouldn't think twice about trying plastic surgery in the future. That's a far cry from the old days, when Hollywood stars conjured up elaborate stories about “visiting health farms” to explain away their rejuvenated looks.

But why do “average” people have procedures done? Atlanta resident Eleanor Lowry is in her mid-60s. She decided to have a facelift simply to make herself look and feel better. “I did it for self-improvement,” she says. “I decided that I shouldn't hesitate any longer. I wasn't depressed about my image - I'm not a person who gets depressed - I just wanted a more youthful look. I'm single, and I wanted to see a younger face when I looked in the mirror.” This desire for youthfulness, Lowry maintains, comes from a paradigm shift in our concept of the elderly. “We don't have the image anymore of the typical grandmother and great grandmother that we had 50 years ago - with the white hair and the wrinkles from hard work and worry. There are so many of those women that I admired growing up, but . . . we have changed our image of older people because we are all so health conscious now.”

Looking more youthful in your mid-60s is understandable, but earlier, preventative treatment is become more prevalent, too. Renee Tompkins, another Atlantan, is only 45, yet she's had her upper eye lids worked on, laser treatment on her entire face, lip augmentation, and a chemical peel on her neck and chest. “Looking in the mirror in my late 30s I got the first urge to do it,” she says. “I had a lot of heavy skin on my upper eye lids. When I go and look back at pictures of my mother I see that she had the same thing.” She adds that her mother has always wanted to have plastic surgery but now that she's in her 70s her health won't allow for it. “She feels like she's in her forties until she looks in a mirror. She wants to look outside like she feels inside.”
Both women, however, maintain that they had plastic surgery in order to change the way they looked to themselves - to match their external, aging appearance to their internal youthfulness - and not to impress others. “It's all about self-satisfaction,” says Lowry. And Tompkins echoes that point: “If I had a girlfriend who was seeking it out to make her husband happier, I would caution her against it,” she says. “It should be for yourself.”

The average price of a nose job today is $5,000, down from around $11,000 a decade or so ago. It's even less expensive when patients go abroad. Enterprises like Surgeon and Safari, a South African-based company that promotes medical tourism, combines plastic surgery with an African safari. As Colleen Hiltbrunner, a woman who underwent the Surgeon and Safari experience for herself, writes on their website, “The opportunity to see the animals in their natural habitat, to go where man originated and, at the same time, get the plastic surgery I need at a bargain rate, is just fantastic.”

Coupled with the disappearance of any social stigma, the cheaper price tag means that more and more people are not only trying out a nip or a tuck - they're proud of it. A national survey of 1,000 adults was conducted last year by the American Society for Aesthetic Plastic Surgery (ASAPS). The results showed that 54 percent of respondents approved of cosmetic surgery, and 24 percent would consider it for themselves. Three-quarters claimed that if they had cosmetic surgery, they wouldn't be embarrassed if others knew.

But even though cosmetic surgery has gained in social acceptance to the point where clinics advertise “Botox blowouts,” that doesn't mean that all surgeons are willing to take on just any patient. Brian P. Maloney, M.D., F.A.C.S., head of the Maloney Center in Atlanta, describes the unique aspect of the plastic surgeon's waiting room: “A general surgeon's waiting room is filled with people who have their rosary out, because they don't want surgery. The unique thing about my waiting room is that everyone in it wants surgery. So they're checking me out - but I‘m checking them out, too.”

And Dr. Maloney turns away patients with unrealistic expectations. “If I don't feel like I can help them - if they want the bump on their nose removed, and there is no bump on their nose - then I turn them away,” he says. “I educate them and then I select out the ones who think in black and white and who want black and white results. Because this is not black and white. We work in the gray. If someone is focused on perfection, they don't need plastic surgery. They have a personality disorder.”

WHO'S HOLDING THE KNIFE?
“Reconstructive or plastic surgery is to take an abnormal feature and improve it towards a more normal feature,” says Dr. Maloney. “Cosmetic surgery is to improve a normal feature of the face.”

As it stands, just about any doctor can offer cosmetic surgery, whether they are a gynecologist or a pediatrician. In California, there's a bill making its way through the state senate that could make it legal for some oral surgeons to perform facial plastic surgeries, including facelifts and nose jobs. Dubbed the “Nip, Tuck and Crown Bill,” it's causing great concern in the plastic surgery community. According to an article in The New York Times, Thomas Hiser, President of the California Association of Oral and Maxillofacial Surgeons (OMS), wants qualified oral surgeons to be allowed to perform “elective cosmetic surgeries” in the area around the neck and face (OMS already perform reconstructive plastic surgeries in emergency rooms).

Board Certified plastic surgeon, Dr. Leonard Glass, is against the bill. “(Oral surgeons) are doing facial injuries. That's a far cry from someone who is looking fine as they are, but want to look a little bit better . . . They think it's an opportunity to make a bunch of money by doing cosmetic surgery.”

Dr. Hiser counters: “It's a turf war, okay? . . . It's discretionary dollars by the patient and it's a lucrative field.” If that seems venal, it may be comforting to know that surgeons like Doctor Maloney believe that the most important skill a surgeon should have is integrity, “followed by listening and understanding the concerns and goals of the patient,” Maloney says. “Having true integrity, genuine compassion and understanding the delicate balance between artistry and skills is paramount. The problem is that the training of a physician is a unique process. It requires ego to get you through the long hours, but at the end of the day you have to remember that you are there to help the patient. You have to listen to their concerns.”

The difference between having your dentist versus a Board Certified doctor perform your facelift is vast. Being Board Certified means that the doctor has gone through specific and extensive training in a specialized field and has passed a difficult examination by a board of experts in that field. Board Certified plastic surgeons argue that this is a critical issue of public safety that isn't just about botched nose jobs, but about people dying.

THE SOUTHERN BELLE
In sixth century India, surgeons first developed the basics of an operation known as “the attached-flap method” which was used to repair the damage inflicted on people found guilty of adultery - the cutting off of the nose.

Not exactly the way they do it at The Maloney Center, but as crude as the operation was it did, in fact, pave the way for what transpired in early October 2004, when a team of surgeons successfully performed the very first reconstruction of the entire face of a burn victim. The procedure received virtually no play in the press - certainly not as much attention as the media gives debate over whether actress Lindsay Lohan has had breast implants. (She says “not.”)

As it happens, plastic surgery is especially popular here in Atlanta, “due to the Southern belle philosophy to look your best,” says Dr. Maloney. He sees many white collar professionals in his office - many of them men. “What's fascinating is that over the past 10-15 years the number of guys getting plastic surgery has increased dramatically,” Dr. Maloney says. “A lot of people see it as a career move, where men and women in the corporate world try to keep their edge against the young people in the office.”

The group of professionals that Dr. Maloney says he treats more often? Attorneys. “They are up in front of juries, up in front of people all the time,” says Dr. Maloney. “They really know the value of maintaining their appearance. If you have a sharp image, it puts people at ease. . . When we look at someone and say, ‘There is a beautiful person,' what that means is that there's a person whose features are proportioned and balanced. . . People have more of a comfort feel with good looks.”

THE NEW AGE
We are, by all accounts, in a new age of plastic surgery. Techniques that are commonplace today were the stuff of science fiction 10 years ago, and the future is coming fast. Many physicians these days believe that unraveling the mystery as to why fetal wounds heal without scars will revolutionize plastic surgery and medicine generally. Moreover, through robotics and morphing computer software, patients will be able to visualize not only what they'll look like after surgery, virtual reality will allow them to sense what they will feel like, too. It's a far cry from the days when Gasparo Tagliacozzi, professor of surgery at Bologna in 1597, used to perform primitive nose jobs by grafting skin from the upper-arm and allowing one end to remain attached to the arm so it could be nourished by the body's own blood.

Doctor Maloney is philosophical: “I grew up in rural Ohio, on 13 acres of land,” he says. “My roots are humble and simple. I'm a hopeless romantic, I guess . . . I think that true beauty is on the inside; our true self-confidence is on the inside.” But, he says, if someone “was born with a huge nose, or if the sun and time have made someone look tired, then being able to reverse those changes is such an awesome experience - watching that impact. I have the greatest job in the world.”

Who do you want to look like?
Plastic Surgeons-to-the-stars reveal the eighth annual “Hollywood's Hottest Looks” survey

BEVERLY HILLS, CA - It's that time of the year! Celebrity plastic surgeons, Richard W. Fleming, M.D. and Toby G. Mayer, M.D., have released the results of their annual “Hollywood's Hottest Looks”

“This is our eighth year conducting this survey and our patients still continue to surprise us with their top picks of celebrity features,” explained Dr. Fleming, co-director of The Beverly Hills Institute of Aesthetic & Reconstructive Surgery with his partner, Dr. Mayer. “With the heightened awareness of celebrity cosmetic surgery, our patients are not only telling us what they want, but now they are telling us what they don't want to look like.”

DESIRED FEMALE FEATURES

NOSE: HAIR: BODY: LIPS:
Charlize Theron Sarah Jessica Parker Jennifer Garner Scarlett Johansson
Diane Lane Jennifer Aniston Beyonce Knowles Jessica Simpson
Nicole Kidman Debra Messing Halle Berry Gwen Stefani

JAWLINE/CHIN: EYES:
Uma Thurman Catherine Zeta-Jones
Hilary Swank Natalie Portman
Kate Winslet Julianne Moore

CHEEKS: SKIN:
Cate Blanchett Kate Hudson
Julia Roberts Paris Hilton
Cameron Diaz Kirsten Dunst

DESIRED MALE FEATURES

BODY: NOSE: HAIR:
Jamie Foxx Brad Pitt Hugh Grant
Tom Cruise Colin Farrell Pierce Brosnan
Hugh Jackman George Clooney Colin Farrell

JAWLINE: EYES:
Leonardo DiCaprio Keanu Reeves
Orlando Bloom Leonardo DiCaprio
Matt LeBlanc Josh Lucas

CHEEKS: SKIN:
Jude Law Jude Law
Antonio Banderas Matthew Perry
Denzel Washington Matthew McConaughey

CHIN: LIPS:
Ben Affleck Brad Pitt
Johnny Depp Ashton Kutcher
Russell Crowe Matt Damon

OVERALL CLASSIC BEAUTY! MOST UNDESIRABLE LOOKS
Helen Gurley Brown Michael Jackson
Carolyn Murphy, Estee Joan Rivers Marie Osmond
Lauder Spokesmodel Burt Reynolds Janice Dickinson
Mickey Rourke Bruce Jenner

Dr. Brian P. Maloney
Facial Plastic Surgeon
Atlanta, GA
(404) 252-5438