Dr. Sevinor has contributed articles on reconstructive and cosmetic surgery in major publications such as: The Boston Globe, The Boston Herald, Boston Magazine, USA Today, the Associated Press, Harpers Bazaar, Mademoiselle, The South China Post, The London Sunday Mirror, Woman’s Own (U. K.), and Der Spiegel (Germany).

USA Today (Society for the Advancement of Education), Sept, 1994 by Sheldon J. Sevinor

ARISTOTLE said that “Beauty is a greater recommendation than any letter of introduction,” but is it? David Hume wrote in 1741 that “Beauty is not a quality in things themselves; it merely exists in the mind that contemplates them, and each mind perceives a different beauty.”

More than 2,000,000 cosmetic procedures are performed annually. There are 72,000,000 baby-boomers who are approaching their 40s and associate looking good with success. What do they want to achieve with cosmetic surgery, and are their expectations realistic?

A plastic surgeon must be a keen psychologist and understand why a person decides to change some aspect of his or her appearance. There is a relationship between self-image and the desire to change one’s looks. The surgeon must be aware of the patient’s psychological stability, mood, expectations, motivations, and goals. A brilliant surgeon and scalpel can not revive an ailing marriage.

Residency training programs in the U.S. do a superb job in teaching young doctors to master the technical skills required for plastic surgery, but little time is spent studying the appropriateness of such a procedure from the psychological aspect of the patient profile.

Choosing the appropriate patient is as important as selecting the correct procedure. Physical appearance is one clue to determine whether he or she is a good candidate. Is the patient disheveled? Does he or she have a defect which is only minimal? Has the patient already had a number of plastic surgery procedures performed? In other words, is he or she a plasti-surgiholic? Is the patient a “super-perfectionist” or a “shopper”?

The manner in which the patient conducts himself or herself during the initial consultation is important. Is he or she rude, overly solicitous, critical of other surgeons, depressed, arrogant, or vague? Any one or a combination of these elements can signal unrealistic expectations. Such a person never can be satisfied.

During the evaluation, it should be determined whether the patient has suffered a loss. Has he or she lost a job or a loved one? Changes in one’s life can produce tensions. Some individuals are prompted to seek plastic surgery as a means to cope with added stress. Moreover, if the patient is undergoing psychological treatment, he or she may not be in a position to make a fully informed decision about plastic surgery.

Even if none of the aforementioned elements are present, I still may choose not to perform surgery on an individual with whom I do not feel comfortable. The final stage in the evaluation is whether he or she even is willing or capable of following instructions before the proposed procedure. If not, a surgeon seriously must reconsider whether to operate.

There are limits to what can be accomplished by a plastic surgical procedure. Important variables such as a person’s state of health, skin texture, age, and personality type will determine how close the operation will come to his or her expectations. Improvements may be expected, not perfection.

A plain-Jane who is convinced that a facelift automatically will bestow ravishing good looks needs to be told a plastic surgeon can not create a Venus, if the basic elements for beauty are not already there. The doctor is working with human skin, not clay. Such a patient must be advised that a facelift will not make her stunning, but can render her free of wrinkles and impart a rested appearance.

The ordinary looking man who persists in the belief that he can be transformed into an Adonis should be reminded of well-known people who fell far short of popular standards of beauty. Winston Churchill is one example. Eleanor Roosevelt, Golda Meir, Indira Ghandi, and Margaret Mead became attractive with age. None of these women were graced with “a face that would launch a thousand ships,” but their charm, talent, and intelligence transformed them in the eyes of their beholders.

There are yet others whose essence would be lost if they had undergone plastic surgery. Imagine if Barbra Streisand chose to have a rhinoplasty. Her voice would remain intact, but a surgically transformed proboscis would change forever her essence in the minds of others. Her nose is linked inextricably with her voice. It is part of her identity. Envision Yul Brynner with a hair transplant. Ralph Waldo Emerson once said that “One man’s identity is another’s ugliness.”

Men seek a new image

According to a survey conducted by the American Society of Plastic and Reconstructive Surgeons, an increasing number of men are having aesthetic plastic surgery. They accounted for 25% of the more than 70,000 nose jobs, 14% of 73,000 eyelid tucks, and 10% of 54,500 facelifts.

Men no longer feel inhibited to consult with a doctor about aesthetic surgery. Males constitute about 20% of my cosmetic surgery patients. An increased interest in aesthetic plastic surgery is connected with the social acceptance of self-improvement. Everyone feels that cosmetic surgery no longer requires apologies.

Men are pursuing facelifts and eyelifts in much the same fashion as they did hairstyling years ago. Even skin care, once viewed with disdain, is now of concern to them. In addition to improving their physical appearance, plastic surgery can give men the winning edge. Many people have read or heard of the Wall Street Journal study that showed promotions went to those who were younger looking and more attractive. It also is well-known that, when two people of equal standing are considered for a position, the more attractive one is chosen.

One’s emotional and psychological well-being should be a concern even after the procedure. The usual treatment process consists of a consultation, operation, and discharge, with a follow-up visit in a week. It is a long process, and the recuperative period often is forgotten, which is ludicrous considering the amount of money people spend on the surgery. In Europe, some surgeons use health spas as a place for their patients to recuperate. With elective surgery, the patient is not really sick, so why prolong a stay in a hospital environment?

In my practice, for example, patients have the option of recuperating in the Copley Plaza in Boston. There, they not only have all the service and amenities of a luxury hotel, but the discreet and meticulous attention of its staff. Moreover, the cost is far less expensive than remaining in a hospital. Of course, the hospital is necessary for the actual surgery, and no one is discharged from it until he or she is stable and comfortable. The hotel stay eliminates the stress factor that many patients experience when they first arrive home. With most cosmetic surgery, there is some swelling, and anxiety can increase it and slow down the recovery process.

Once thought of as mainly for the rich and famous, cosmetic surgery has become an important part of our youth and fitness oriented society. Plastic surgery offers another means to improve an individual’s self-image if the patient has realistic expectations. While operations such as a facelift or tummy tuck may not be performed for physical health or safety, they often benefit patients emotionally and psychologically. At the same time, individuals must realize that plastic surgery is not a panacea. It is not the answer to life’s problems. Cosmetic surgery can improve a person’s appearance and self-confidence, but only if the patient’s state of mind is positive before the operation.

COPYRIGHT 1994 Society for the Advancement of Education

COPYRIGHT 2004 Gale Group

LIFTS AND TUCKS

by Phyllis Tannenbaum Lynn Magazine, June 1986

During the last ten years, Christine has had her nose fixed, eyelids lifted, breasts enlarged, thighs reduced and she is already planning for her next cosmetic surgery – a face lift.
Christine is a forty-year-old computer executive from Peabody. Look, she says, I know some people would call me a plastic surgery junky, but as I see it, there is always some physical part of you that you don’t like. Ordinarily, people dont do anything but complain. I do something about it. Say I have some extra money. I can take a trip or maybe have my small breasts, which I’ve always been very sensitive about made larger. A trip lasts one or two weeks. New breasts last forever. Now which one makes more sense?
Christine is an extreme example. Most people don’t have multiple procedures, but cosmetic surgery is on the rise. And the reasons people are doing it are as varied as the results.
There’s the mother of three from Swampscott who has devoted her life to her family and now, at fifty, she feels its time to do something for herself;
…the flat-chested eighteen year old who thinks that if she goes off to college filling out a B cup bra, shell be more popular.
…the thirty year old woman who is tired of suffering from the back strain, poor fitting clothes and snide remarks caused by her large breasts.
…the male vice president of a large corporation, threatened by the younger men in the market place, feels that a facelift will make him better equipped to compete.
…and then there’s the man who thought cosmetic surgery might make him looks less sad and thus more lovable.
The American Society of Plastic and Reconstructive Surgeons statistics appearing in a recent Newsweek article, showed that plastic surgery rose sixty-one percent between 1981 and 1984, and that the most popular procedures were breast enlargements and eye lifts. There were 72,000 cases of breast enlargements and 56,000 cases of upper and lower eye lifts. The article stated that the Society estimates that its 2,700 certified surgeons performed some 477,000 operations last year and what it calls esthetic surgery.
People have cosmetic surgery for many reasons. Dr. Barry A. Davidson, clinical instructor of plastic surgery at Tufts Medical School, says, People have eyelid surgery because they worry about wrinkles,sagging of eyelid skin, looking tired even when they’ve had a good night’s rest, and sometimes when the condition of the eyelid has progressed to the point of visual impairment.
Women have their breasts enlarged or reduced because they feel bad about themselves, explains Dr. Robert M. Goldwyn, clinical professor of surgery at Harvard Medical School.
Overly large breasts can be a real impediment, says Dr. Goldwyn.They’re cumbersome and can cause neck pain and rashes. There warm in summer, they can distort interpersonal relationships and restrict physical activity.
Dr. Goldwyn adds that five to ten percent of cosmetic breast surgery is performed on men. Fat or overly muscular boys have breast reductions as a release from psychological embarrassment. Men with prostate cancer, who are given estrogen sometimes develop breasts. Some older men suffer from breast enlargement as do many men who smoke marijuana.
If notable scarring occurs after breast reduction, more than one procedure may be required. The patient may have partial or even complete loss of nipple sensitivity and the chance of nursing is decreased by fifty percent.
Eyelidplasty can result in blindness. It only occurs in half of one percent of all cases, but the patient should be warned about it, says Dr.Goldwyn. The surgeon can also remove too much tissue resulting in the “basset hound look” and excess scar tissue or prolonged swelling or discoloration.
As Dr.Eugene H. Courtiss, associate clinical professor, plastic surgery, Boston University says, “You cant bat 1,000 every time.” But what, if any, is the selection process used to find out who makes a good candidate for a particular type of plastic surgery? It is important”, Dr.Courtiss explains, “for a person to have realistic expectations and psychological and physical health.” Even Christine says, “Anyone who goes into this thinking she’s going to come out looking like Liz Taylor at twenty is in real trouble.”
Dr.Sevinor says, “The best compliment a plastic surgeon can receive is when a face-lift patient tells him My friends say how rested I look and ask if I have been on vacation!” Since 1981 two new trends have evolved in cosmetic surgery: more and more men are having it performed and both sexes are having suction lipectomy.
Dr. Courtiss was one of the first doctors to perform a suction lipectomy in this country. Developed in Paris in the late 1970s, suction lipectomy removes fat in localized areas. It usually takes about an hour and a half and costs between $1,500 and $4,000.
Only a few of the more popular cosmetic procedures have been mentioned. There is also sanding, or surgical dermabrasion, collagen implants, chin surgery (mentoplasty), ear correction (otoplasty), breast reconstruction, tummy tucks (abdominoplasty) and other body contour surgery. Insurance does not cover many of these operations and fees are usually collected before surgery.
So if cosmetic surgery if expensive, painful, causes discomfort, and is potentially hazardous, why are so many people having it done?
Psychologist Judith Jordan of McClean Hospital says, “You have to look at the culture that causes this. Most of the patients are women. Women are raised to over-value their appearance. Their self esteem is tied up with whether or not they perceive themselves as attractive by society at large.
This is an age of narcissism and there is a strong pull for certain standards of beauty. Men are also subject to this.” Youthfulness is paramount. Youthfulness that doesn’t show wrinkles, sagging skin, or serve to remind us of any suffering that we may have experienced in our lives. I think people should be very cautious before taking this step.”
But most of the people who have had cosmetic surgery are very happy that they did. “My patients say the results are very gratifying,” says Dr.Sevinor. Christine says that she would do it all over again if she had to.
Susan, a fifty-two-year-old housewife from Marblehead, was so delighted with the outcome of her face-lift that four years later she had a suction lipectomy.
And Mario, a Newbury Street hairdresser, says he feels like a new man after having an eyelift. Well, that goes to show that they don’t call it a “lift” for nothing.

HOW TO FIND THE RIGHT SURGEON
You want a surgeon who is warm, honest, competent and easy to talk to. If you’re not satisfied, go to someone else. He or she may be the doctor, but its YOUR body!
Ask your family doctor, gynecologist, friends, local hospital, county or state medical society.
Is he board certified? Does he publish? Does he teach and if so, where? What societies does he belong to? Where did he go to school? How many years did he train?
QUESTIONS TO ASK
1. How often do you perform this operation?
2. Is it dangerous?
3. What are the complications?
4. Where will the incisions be?
5. Will there be scarring?
6. How is the operation performed?
7. How long is the operation?
8. Will it be performed on an out-patient basis?
9. Where will it be performed?
10. Am I a good candidate?
11. What anesthesia will be used?
12. Will anyone else be in attendance?
13. What are the limitations?
14. How much pain will there be?
15. How long will I be black and blue?
16. How long will the swelling last?
17. Will I see you after the surgery?
18. Will you take out my stitches?
19. When can I resume normal activities?
20. What is the cost?