Surgery Course
Dr. David Metzner’s 10-Part E-mail Course:
“Cosmetic Surgery- A Guide to Success”
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Lesson 1: How Cosmetic Surgery Can Minimize the Effects of Aging
Have you ever read the book Tuck Everlasting by Natalie Babbitt or perhaps seen the movie? The plot revolves around a family who hides its possession of a fountain of youth — each person who drinks from the fountain forever appears the age at which he or she took the fateful drink. The father always appears to be in his 40s and the children always look like teenagers even though they are hundreds of years old.
Ah, to look young forever! Who wouldn’t like to keep the smooth, rosy cheek or taught firm stomach of youth? That’s why you’re here right? Well, I’m not secretly dispensing sips from the fountain of youth, but I can help you minimize the effects of aging. Through cosmetic surgery I can smooth the wrinkles on your brow, lift the droop in your cheek and firm up your stomach.
In my practice, I perform a variety of cosmetic and aesthetic procedures. Their benefits are to reduce the appearance of the wrinkles and sagging that age us all, or to modify, contour and enhance the face and body. They include:
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Face Lift
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Neck Lift
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Forehead Lift
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Eyelid Lift
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Neck Liposuction
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Lip enhancement
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Skin Resurfacing
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Botox
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Crease and wrinkle filling
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Breast Augmentation
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Breast Lift
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Breast Reduction
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Male Breast Reduction
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Tummy Tuck
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Arm Lift
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Tumescent Liposuction (liposuction from the abdomen, waist, hips, thighs, knees, legs and arms)
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Rhinoplasty (reshaping of noses)
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Otoplasty (reshaping of the ears) and
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Facial Feature enhancement (including chin and cheek implants)
With my aesthetic and cosmetic expertise, you can appear younger; you can appear to have turned back the hands of time. Or perhaps your goal is enhancement of your face or body regardless of age. Doesn’t that sound better than drinking magic water and being frozen as you are?
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Lesson Two — How to Choose the Right Doctor
When trying to choose a plastic surgeon, don’t be afraid to ask people if they know one. If you know someone who has had a procedure done, ask. They will be glad to give you a reference. If you have a friend in the medical profession, ask. Ask your hair stylist, ask the salesperson at your makeup counter, and ask around at the gym. These are all good places to gather names of cosmetic surgeons, and if you can’t gather any personal recommendations, use the internet.
Once you have a list of names, go down the list and check the credentials of each doctor. That is so important that I will repeat it: check the credentials. Make sure the doctor is certified by the American Board of Plastic Surgery and operates in accredited medical facilities. The reason this is so important is that a doctor does not have to be certified in a specialty area to practice in that area. There is a recent trend for specialists in other areas with little or no plastic surgery training, even non-surgeons, to claim that they are qualified to perform plastic surgery. Look for state accreditations, membership in professional organizations, and certifications of specialty. Basically, this is one area where the more credentials you see, the better. To check my credentials, click here
After you’ve checked accreditations, set up an appointment to meet or talk with your surgeon. It’s much better to get a personal consultation rather than just a phone interview. However, initial consultation using emailed photos and the telephone is an option when your surgeon of choice is out of town. When you speak with your potential surgeon, ask the following questions:
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Does he or she have hospital privileges to perform cosmetic surgery? Where?
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Is the surgical facility accredited?
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How many of type of procedure you want has he or she performed?
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Ask if you’re a good candidate for the type of procedure you want.
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What do you have to do to get optimal results?
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What are the risks involved?
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How long is recovery and what’s involved?
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Are there alternatives that are better for me?
The doctor should welcome all of your questions and answer them thoroughly, clearly, and patiently. He or she should be solicitous of your thoughts and feelings and ask you a lot of questions in return. The surgeon should not be afraid to offer alternatives if they are appropriate. You should not feel like you’re being pressured into surgery. It is important for the surgeon to leave the final decision to you.
Choosing the right surgeon is one of the most important things you can do to ensure the success of the procedure and your satisfaction with it. If you are uncomfortable with or not confident in the surgeon for whatever reason, choose another one. After all, it’s your appearance and your health that is at stake.
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Lesson Three — How to Choose the Right Procedure
There are many, many cosmetic procedures out there, and chances are you don’t want or need all of them. Aside from the cost, who wants to end up looking like Joan Rivers? You may already have in mind that you want a face lift, but what does that mean, really? Do you want a forehead lift or an eyelid lift or cheek implants or skin resurfacing? How do you decide?
The first factor to consider when contemplating cosmetic surgery is to focus on what your areas of concern are; what about your appearance are you dissatisfied with? In other words, clarify your goals. It will then be possible to figure out what procedures to consider, and whether you are a good candidate. For instance, if your concern is a double chin you will need something different than if your concern is wrinkles. As another example, women with very large breasts are not ideal candidates for scarless breast reduction. As I mentioned in Lesson Two, How to Choose the Right Doctor, you should ask your surgeon whether you are a good candidate for the procedure when you visit for a consultation. He or she will tell you if you aren’t and will suggest alternatives.
Along the same lines, you could leave the decision up to your surgeon. At the consultation, discuss what you want to look like and ask for suggestions for the best procedures for you. After all, it is the surgeon’s job to make people look better than before, and he or she probably has very good ideas that you haven’t considered. This is an especially good thing to do if your surgeon also happens to be an aesthetic plastic surgeon, like me, or has an artistic background. To review my credentials and artistic background, click here need a link here or visit http://www.drmetzner.com/
If you have a few procedures in mind and are a good candidate for all of them, consider the risks and benefits of each individually and in combination. For instance, the many versions of mini-facelift can give good results, but do not correct as many areas as a complete facial rejuvenation procedure will. Breast lift leaves more visible scars than augmentation, but lift and implants accomplish different things and both surgeries have high rates of patient satisfaction. Some procedures may have to be “touched up” every few years; think about whether you want to follow up again and again. Also, remember, some procedures have more dramatic results than others. Consider whether you care if your neighbors or co-workers are able to tell that you’ve had surgery.
If you don’t already know what procedure you want or even if you think you do, it’s worth researching on the internet and talking with your surgeon to make sure you’ve made the right choice. After all, you’re the one who will live with the results of the surgery.
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Lesson Four — Costs, Financing and Insurance
Though the cost of cosmetic procedures has dropped in recent years, most are still somewhat expensive, ranging anywhere from a few hundred to thousands of dollars, and cosmetic surgeries are not covered by health insurance. While cost is not a factor for some, many cosmetic surgery patients seek financing.
I will start by mentioning something that is not financing, per se: asking someone else to pay. Ask someone who loves you if they will pay for the surgery as a gift. You’d be surprised how many people get surgery this way. If that’s not an option, try asking someone close to you for a loan. Chances are they won’t review your credit history or charge you (very much) interest. Still, make sure you can pay them back. You want people to think of how happy and confident you are when they see you, not how much your happiness and confidence cost them.
Most plastic surgery practices, including mine, accept credit cards and offer financing. Some people do finance their plastic surgery with credit cards, and this may be an option for you, but consider it carefully. Credit card interest rates are usually higher than interest rates for other types of financing, and the card issuers can levy stiff penalties and fees for late payments or carrying a balance too long. Financing is the most viable option for many people.
You can apply to your bank or credit union for a loan, though they might ask you what you want the money for, and some traditional financial institutions are not keen on making loans for cosmetic surgery. That is why there are banks and lending institutions that specialize in cosmetic surgery financing. Visit my website, http://www.drmetzner.com/ , to find a lender who specializes in cosmetic surgery and healthcare financing.
The options available for cosmetic surgery financing are varied, but not complicated. Still, any time you borrow money you should be well aware of what you’re getting into.
Cosmetic surgery is a big investment in yourself. Keep quality and safety upper most in your mind as you decide whom to entrust your body to. While you don’t want to pay more for it than necessary, it can be a serious mistake to spend less than you should to get the result you deserve. Borrow wisely so your new look is a positive enhancement to you, not a financial drain on you.
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Lesson Five — Things to Think About Before Your Procedure
This lesson is basically a checklist of things to take care of and think about before you undergo major cosmetic surgery - facial rejuvenation, breast augmentation or major liposuction or something like that. However, there is one pre-surgery issue that applies to all cosmetic procedures: cold feet. It is common for people to have doubts about cosmetic procedures as the day of surgery approaches. Talk with your surgeon to see if you really are having serious doubts, or if you are just second-guessing what is a good decision. It also might help to keep a journal and seek out support from others who have undergone or are about to undergo plastic surgery. The internet is great for this. In my practice, we have patients willing to discuss their experiences with you.
Once you are mentally prepared for the surgery, here are some other physical things to take care of:
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Have your primary care physician run a complete battery of blood tests if your plastic surgeon recommends it. This will help to catch any potential complications caused by anesthesia or antibiotics.
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Exercise and eat right, including plenty of protein. A healthy body recovers from surgery faster and more easily than an unhealthy one.
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Quit smoking at least one month before surgery. Doing so makes your body better able to withstand surgery.
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If you don’t have someone to take care of necessary household chores while you recover, take care of them in advance.
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Even if you do have someone to take care of household chores, take care of personal chores such as waxing and getting a hair cut.
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Plan your wardrobe so that you have comfortable, loose-fitting, attractive clothing to wear for a week or two after. Some body contouring and breast enhancement procedures will cause swelling.
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Ladies, remove all nail polish from your nails. Doctors will look at your nails to determine if there are circulatory problems caused by the anesthesia.
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Stop taking aspirin and ibuprofen and other “blood thinners” two weeks prior to surgery. Ask your surgeon for a complete list of things to avoid.
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If you are going to have a procedure that will cause visible or significant scars, ask your doctor about strategies to help reduce them.
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Ask about pain and anti-nausea prescriptions.
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Take “Before Pictures.”
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Lesson Six — What Happens During Surgery
Most cosmetic surgeries are relatively straightforward. Depending on what you are having done, they can take an hour to several hours to perform. They are usually done on an outpatient basis, either in a hospital or in an out-patient surgical facility. You will likely be under general anesthesia during the procedure, though some are with a local anesthetic and a sedative. If under a general anesthetic, there will be probably be an anesthesiologist, a Medical Doctor specializing in anesthesia care, present during your surgery. Ask to be sure this is the case.
Almost all surgical procedures will require incisions, and some will be less visible than others. For instance, liposuction tends to leave very minor incision scars in inconspicuous places. Other procedures require more extensive incisions, but plastic surgeons are experts at minimizing and hiding them to the extent possible without compromising the result. During the surgery, the doctor may place temporary drains in your incisions to keep fluids from building up immediately after surgery.
Some procedures — for instance some types of breast reconstruction after cancer surgery — are two step procedures. You may have to have a surgery, recover, and then have another surgery at a later time. These surgeries, regardless of whether they are one procedure or more, tend to be longer and require extensive incisions.
You will probably go home or to your hotel after the procedure, though some patients remain in the hospital for a day or two. Either way, your surgeon will see you as often as indicated to follow your progress, to monitor the draining of fluids and to watch for signs of healing problems or infection. Drains, if used, are removed one to several days after surgery, once drainage tapers off. If you have stitches that are not self-dissolving, they will be removed five to seven days after the surgery.
What happens during your particular procedure, of course, varies with each individual. Be sure to have your surgeon walk you through the surgery in preparation for it. This includes the goals and limitations of the procedure(s) you have chosen, location of all resulting scars, and potential complications.
This lesson was kind of short, but consider it a break — there is a lot to go over about the recovery process so the upcoming lessons will be longer and more detailed.
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Lesson Seven — After Your Procedure: Recovery
As explained in the last lesson, you will probably go home or to your hotel after the procedure, though some patients remain in the hospital for a day or two. Either way, your surgeon will see you as often as indicated to follow your progress, to monitor the draining of fluids and to watch for signs of healing problems or infection. Drains, if used, are removed one to several days after surgery, once drainage becomes scant. If you have stitches that are not self-dissolving, they will be removed five to seven days after the surgery.
Your first 24 to 48 hours at home can be rather dicey, depending on the extent of your surgery, because you are still at risk for complications and you will have reduced mobility. You may not be able to do much for yourself during this time - feeding yourself, bathing, dressing, getting a drink or even sitting up may require help. Be sure to have your significant other or a designated helper monitor and take care of you during this time.
The amount of pain you experience after cosmetic surgery depends on the type of procedure and on the individual. Some breast augmentation procedures can be quite painful, and some women experience no pain at all. Before the procedure, ask you surgeon about whether you will need pain medication, and get a prescription. Keep ice packs on hand. Some patients say it helps to sleep through the pain.
The good news is that most people do well after cosmetic surgery. The bad news is that almost all surgical patients swell, a lot. Swelling is one of the body’s defenses against trauma, which major surgery is. Swelling is usually most pronounced three to five days after surgery, and, on average, will be 75% gone within two to four weeks of surgery. The remaining swelling will resolve itself over the course of a few months. Don’t examine your surgery results too closely for about two weeks after surgery; the swelling and bruising during that time may give you an unpleasant surprise. Just remember: these effects are only temporary.
You should be able to remove your bandages and shower within a few days of surgery, though it may be a while longer before you can take a full bath. You can resume exercise in one to six weeks depending on your procedure. You can return to work in two to ten days, again, depending on your procedure, though you may have restrictions on your physical activity. If you are traveling some distance to have your procedure, it should be OK to travel within a few days. Do remember, whether traveling by plane or car, to get out of your seat and walk around at least every 2 hours to reduce the risk of blood clots in your legs.
All in all, recovery after cosmetic surgery isn’t that long, but it can feel longer than it is because of pain, nausea, and immobility. It is normal to be inpatient, but Mother Nature can’t be hurried. Knowing what to expect and having someone to help you through it can make recovery after surgery much faster and easier, so you can get on with enjoying your life and your new look.
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Lesson Eight — After Your Procedure: Complications
As with any surgery, part of the risk of cosmetic surgery is related to undergoing the surgery itself. Surgical complications include excessive bleeding, infection, and a poor reaction to anesthetic. The chances of having these complications can be minimized by following the doctor’s pre-surgical and post-surgical instructions. In the event that there are complications, they are usually easily managed by a skilled and experienced surgeon. Pain, swelling and a limited range of physical motion will follow the surgery. Your surgeon may insert drains to reduce the chance of complications caused by excessive swelling. The surgeon will ask you to quit smoking and refrain from taking any blood thinners - aspirin for instance - to reduce the risk of complications related to bleeding or anesthesia.
Infection is a complication to be concerned about. Not because it is likely to happen - less than 2% of cosmetic surgery patients contract infections - but because it can be quite serious if left unchecked. Infection can prolong swelling, cause severe scarring, and in extreme cases, force follow up surgeries to undo the procedure. After your surgery, watch carefully for fever, increasing swelling or severe pain, any one of which can be an early sign of infection. Contact your surgeon immediately.
Depending on the surgery you have, some parts of your body may lose sensation because nerve endings will have to be cut or stretched to perform the procedure. This is usually temporary and can happen in any invasive procedure.
Scarring will, of course, result from any procedure that requires incisions. A skilled surgeon will make them as few and as short as possible, and place them in inconspicuous places to the extent possible. Scarring cannot be avoided but it can be minimized. It is encouraging to remember that most scars will fade with time and become unnoticeable to anyone not looking for them.
Finally, each particular procedure carries its own risks. Be sure your surgeon explains them to you during your consultations so that you can make an informed decision about whether the benefits outweigh the risks, and that the risk of complication is worth it to you. Also remember that, despite risks and complications, surveys consistently show that the vast majority of cosmetic surgery patients are very happy with the results of their procedures and would do it again or recommend it to others.
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Lesson Nine — How to Handle the New You
It is easy to find out what the physical risks of cosmetic surgery are, but there is less information on the emotional risks. You should know that cosmetic surgery — particularly extensive cosmetic surgery — has the potential to take an emotional toll on you.
Some people become depressed or anxious after their surgeries. This is particularly so in the early stages, when swelling and bruising and temporary stretching look so bad to the inexperienced. It may seem to be taking forever, but in fact these signs will resolve and as they begin to look better, most people will feel better automatically.
While some surgery can be reversed or fixed if you are unhappy with the results, many procedures are irreversible. Second guessing the decision is not uncommon, particularly for people who have undergone obvious or extensive surgery, and anxiety can mount when they realize the relative permanency of what they have done. Some people report anxiety and depression as a result of unwanted attention caused by their new look. Additionally, stress can be caused by negative reactions by members of both sexes. Some people come out of cosmetic surgery perfectly happy with their procedure only to discover that they are quite unhappy with another part of their body. The problem here may be poor self esteem, and no amount of cosmetic surgery can fix this.
To combat these potential issues, it is helpful to have a support network. Good plastic surgery practices have patient coordinators who are knowledgeable and available to answer your questions and “hold your hand” as you heal. Your cosmetic surgeon will see you as often as necessary. Use these professionals as your most reliable source of information and medical advice. Your family and friends can help you best by listening to you, helping with wound care as instructed, and supporting you in your decision to have cosmetic surgery. It is a good idea before you undergo surgery to consider how you will feel and how you will respond in the event that someone reacts negatively to your new look. It may help to keep a journal. Also, here is where your before pictures can come in handy to remind you of why you have chosen to have cosmetic surgery. Above all, remember that cosmetic surgery is a highly personal decision, and one that most patients are extremely happy with, when all is said and done. You, too, will be happy if you undergo surgery for yourself, and not for anyone else.
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Lesson Ten — How to Maintain the New You
In this course, we have covered everything from whether cosmetic surgery is right for you to how to choose a surgeon to how to finance surgery and what to expect before, during, and after. That’s a lot, but we are not done yet. This last lesson is how to take care of your new look. You’ve invested a lot in looking and feeling more attractive, younger, better about yourself, so it’s worthwhile to do what you can to maintain it.
Some procedures, breast augmentation for example, may require follow up care and surgery. Most cosmetic procedures do not require any kind of maintenance that is this extensive. What I’m talking about here is maintaining a good exercise regimen, eating properly, taking care of your skin, and a generally healthy life style. This is the key to maintaining your new look.
Be sure to get regular exercise - a commonly advised program is at least one hour three days a week — and be sure that you get both aerobic and strength building exercise. Aerobic activity helps you look youthful by pumping blood and oxygen throughout your body, giving you a youthful glow. Strength training tones your muscles, firming up parts of you that may otherwise sag, protects your joints, can improve your metabolism and generally gives you a strong, healthy look.
A healthful diet rich in fruits, vegetables and protein is important in maintaining a youthful look. Fruits and vegetables, particularly darker hued varieties, contain many important vitamins and anti-oxidants that help fight wrinkling and dry skin and hair that come with age. All of your organs and body systems require protein to keep them functioning normally.
Of course, you should avoid those things that accelerate the aging process. Quit smoking - you should have a good head start if you stopped prior to surgery- and limit your exposure to sunlight (always wear sunscreen).
By generally maintaining a healthy lifestyle and diet, not only will you look better, but you will actually feel better. You will be healthier and increase the length and quality of your life. You will actually be a new, youthful you, not just look like it. What better way could there be to compliment and maintain your surgical procedure?
Hopefully, throughout this course you’ve learned a lot about how cosmetic surgery can minimize the effects of aging and enhance your appearance. You are on track to make a decision that could positively impact your life in a big way. The next step is to do more research on the internet and with individual surgeons. If you would like to set up a consultation with me, please feel free to contact me.
All the best,
Dr. David Metzner
Board Certified Plastic Surgeon
69 Union Street
Manchester, VT
802.362.5655
P.S. Please feel free to forward this lesson to anyone you think will benefit from it. If you have received a forwarded copy, you can get the remaining lessons e-mailed directly to you by signing up at http://www.drmetzner.com/