Cosmetic Facial Reconstruction Limits

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What can you expect of plastic surgeons after disfiguring violent acts such as animal bites, acid or heat burns?

Nonconstructive Cosmetic Surgeries

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Though there are many examples of overdone cosmetic surgery, it is generally undertaken to make someone appear more youthful or attractive. This differs from reconstruc­tive surgery that has the goal of correcting anatomical irregularities.

Separating conjoined twins (when practical) or removing extra append­ages are not considered cosmetic. This is often deemed medically necessary. Disfiguring violent acts such as animal bites, acid or heat burns require a series reconstructive surgeries.

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. This is not to be confused with transgender procedures. With FFS, doctors endeavor to make a woman appear more feminine or a male for masculine.

Limits of Cosmetic and Facial Reconstruction

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.

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 or fat injections to add volume. But a loss of plumpness in a face reads old, as do wrinkles or age spots, she said.

Severely Disfigured

Sometimes the end result of reconstructive surgery can only be appre­ciated when com­pared to the initial medical anomaly. 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 is a limit to medical insurance, personal resources and physician philanthropy.

The topic of surgical limitations and acceptance is addressed in the cinematic adaptation of the book Wonder. It stars Jacob Tremblay, Julia Roberts and Owen Wilson. The boy on which the film is based, Trecher Collins, had 53 surgeries by age 11.

Documentary Trecher Collins Syndrome video

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.

As with other severely disfigured patients, Carolyn’s “after” picture may seem more like doctors are just getting started. Measured by the effort to restore basic senses, 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.

Beauty in Perspective

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 perceived age but reveals 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 patients feel better about themselves if performed by a qualified professional. But do not expect to find a fountain of youth on the sharp end of a blade.

Each case is different and results vary. It is easier to impress modest expectations. The quest for perfection can lead down the unending path of dysmorphic syndrome—not knowing when to stop. Follow emerging prosthetics on the Pinterest board entitled Steel Life.

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Kevin Williams is a health advocate, artist, pro­gram­mer, and writer of hundreds of articles for multiple web­sites. He has 17 years experi­ence as a Neutrogena Research and Scientific Affairs graphics con­sul­tant.

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