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Plastic and Reconstructive Surgery FAQ (PRS-FAQ)

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Archive-name: medicine/surgery/plastic
Posting-Freqency: monthly
Last-modified: 1999/06/28
Version: 1.1
Copyright: (c) 1998-1999 Robert A. F. Green
Maintainer: Robert A. F. Green <>

See reader questions & answers on this topic! - Help others by sharing your knowledge



Section C - ERRATA






A.1 - What is this document?

A.2 - What is the purpose of the PRS-FAQ?

A.3 - Where can I obtain the PRS-FAQ?

A.4 - Copyright, Terms and Conditions of use.


Subject: A.1 - What is this document?

This is the Plastic & Reconstructive Surgery Frequently-Asked
Questions (PRS-FAQ), a list of often-asked questions (and their answers)
on the subject of various cosmetic and reconstructive procedures, as well
as related topics.


Subject: A.2 - What is the purpose of the PRS-FAQ?

We have compiled these topics to serve as a central informational
resource to assist prospective patients (and the general public) in
learning about Plastic and Reconstructive Surgery, and related fields.


Subject: A.3 - Where can I get a copy of the PRS-FAQ?

The primary site for the PRS-FAQ and its maintainer is at the
sponsoring web site at <> It is available
here for download in text form. An HTML version will also be available
in the future.

It is available via e-mail request from the maintainer:

It is posted once per month to the following newsgroups:


Subject: A.4 - Copyright, Terms and Conditions of use.

This document is Copyright 1998,1999 Robert A. F. Green, all rights
reserved. It is freely distributable in its original, unedited form for
private use only. No other reproduction, in whole or in part, or as
inclusion as part of any larger work, or other form of distribution is
authorized without the express permission of the maintainer. Mirroring of
the document or linking via the World-Wide Web is welcomed, however please
notify the maintainer (so that links and mirrors may be kept up to date
with the most correct versions of the PRS-FAQ).








Subject: B.1 - Disclaimer

This document is for information purposes only. While every
effort is made to ensure the accuracy of the information contained in the
PRS-FAQ, we cannot guarantee the accuracy of the information contained
here. Additionally, the maintainer is not a physician, and by no means
should the information here be taken as medical advice. This document is
intended for personal study, and the reader is advised (and in fact
encouraged) to consult with a qualified physician for additional
information and actual medical advice prior to making any decisions
regarding surgery or other health care matters. The maintainer(s),
sponsor(s), and contributor(s) of the PRS-FAQ cannot and will not be
responsible for any action made based on information contained in this


Subject: B.2 - Credits

This document is compiled and maintained by Robert A. F. Green
( The information presented here is based on multiple
sources, including (in part) physician interviews, newspaper and other
media articles, and the patient education information of various private
physicians and professional organizations in the appropriate fields.
Credit and thanks must also go the following physicians and

Marco Rizzo, M.D. (who's web site is the sponsor of the PRS-FAQ)

The American Society of Plastic and Reconstructive Surgeons, Inc.

The American Society for Aesthetic Plastic Surgery, Inc.

(Please note that this list is not necessarily complete, and that
additional input and information as well as additional questions, are
welcomed, and will be appropriately credited wherever possible).


Subject: B.3 - Contact info

The PRS-FAQ maintainer is available via e-mail as
You may also contact the maintainer via the sponsoring web site,


Subject: B.4 - Version number and release date

This is version 1.1 of the PRS-FAQ, dated June 28, 1999.
(PRS-FAQ 1.1, 06/28/99).


Section C - ERRATA


Subject: C.1 - Errata

	none this revision




Subject: D.1  - Changes since the last version.

- Addition of information regarding trans-navel breast augmentation.




Section E Contents

E.1 - What is Plastic Surgery?

E.1.a - What kind of plastic do you use?

E.1.b - Why plastic instead of some other material?

E.2 - What is the history of Plastic & Reconstructive Surgery?

E.3 - What is the difference between 'Cosmetic' and 'Reconstructive'

E.4 - What parts of the body can you do surgery on?

E.5 - What are typical costs of the procedures?

E.6 - Is there any visible scarring?

E.7 - What is the typical recovery time?

E.8 - Will the cost of surgery be covered by my medical insurance?
E.9 - How long does _______ take?
E.10 - How long will it take to heal?
E.11 - What are the risks of _____ ?
E.12 - Can you make me look like (fill in name of celebrity here)?
E.13 - What are the most common procedures?

E.14 - Endoscopes and Plastic Surgery


Subject: E.1 -   What is Plastic Surgery?
         E.1.a - What kind of plastics are used?
         E.1.b - Why Plastic rather than some other material?

Plastic surgery is named from the Greek word "plastikos" which
means "to shape", based on the surgeon re-shaping the form
of the patient's form through surgery. It has nothing to do with
the types of materials used in the surgery itself.

In surgery, many different materials may be utilized, depending
on the desired results and the type of surgery. Frequently,
the surgeon will make use of the patient's own tissues, including
tissues from another location of the body, or by reshaping the
existing tissues to achieve a better appearance.

Historically, many materials have been used in cosmetic
and reconstructive surgery, including ivory, wood, and others. In
modern times, hard silicone rubber is a popular material. This
should not be confused with the gel silicone which has sparked so
much controversy through its use as a filler for breast implants.

Subject: E.2 - What is the history of Plastic Surgery?

Information being compiled


Subject: E.3 - What is the difference between "Cosmetic" and
"Reconstructive" surgery?

Generally speaking, if a surgery is done primarily to improve
the health of a person, or the function of an organ, it is
considered medically necessary. Surgeries such as corrective
rhinoplasty to improve air flow through the nose, or eyelid
surgery to improve the field of vision by lifting sagging,
droopy eyelids might fall into this category. These surgeries
may or may not also improve the patient's appearance, but this is
a secondary purpose.

If a surgery is done with the primary goal of improving the
appearance of the patient, this is considered a cosmetic
procedure. Usually these procedures must be paid for out of
pocket, except in some cases of correcting accidental or
congenital deformity.

It is worth noting that these lines are often blurry, especially
in terms of coverage by medical insurance. As an example, a scar
revision for an automobile accident injury may be covered by
an auto insurance policy, yet another surgery, identical from a
medical standpoint, that resulted from an accident fall injury
might not be covered by insurance.

Another example is breast reconstruction following breast
cancer surgery -- some insurance companies will cover this,
while others consider this primarily cosmetic in nature. It goes
without saying that this is a hotly contested issue between those
insurance companies and the affected patients.


Subject: E.4 - What parts of the body do you do Plastic Surgery on?

There are commonly performed cosmetic procedures for virtually
every part of the face, including the neck, nose, eyes, ears
chin, cheekbones, forehead, as well as the breasts and abdomen.
Additionally, scar revision and liposuction surgeries are
potentially possible on most areas of the body.


Subject: E.5 - How much does it cost on average?

Note that the following are averages of *SURGEON'S FEES ONLY* and
you should expect to pay additional fees for almost all of these
procedures to cover the costs of surgical and/or hospital
facilities, medications, nursing care, anesthesia, etc, and that
(for some procedures) these additional costs may total as much or more
than the surgeon's fee itself.

Source: American Society of Plastic & Reconstructive Surgeons, Inc.
        Plastic Surgery Information Service


Abdominoplasty                   Standard fee         $4,050
           Combined with suction Standard fee -       $4,504

Blepharoplasty (both upper lids) Standard fee -       $1,664

               (both lower lids) Standard fee -       $1,752

   (both uppers and lowers lids) Standard fee -       $2,905

Breast Augmentation              Standard fee -       $2,909
       using Endoscope          Standard fee -       $2,917

Breast Reduction                 Standard fee -       $5,230

Breast Lift                      Standard fee -       $3,480

Buttock Lift                     Standard fee -       $4,059

Chemical Peel - full face        Standard fee -       $1,565

              - regional         Standard fee -       $  776

Collagen Injections (per 1 cc)   Standard fee -       $  312

Dermabrasion                     Standard fee -       $1,581

Facelift                         Standard fee -       $4,783

Fat Injections
              - head / neck      Standard fee -       $  987
              - trunk            Standard fee -       $  794

Forehead lift                    Standard fee -       $2,429
         with Endoscopic         Standard fee -       $2,738

Gynecomastia                     Standard fee -       $2,513

Laser Resurfacing  - Full face   Standard fee -       $2,719
                   - Partial     Standard fee -       $1,284

Malar Augmentation               Standard fee -       $2,083

Male-Pattern Baldness Plug grafts
                                 Standard fee -
                          per plug treatment)         $  745

                      Strip grafts
                                  Standard fee -      $1,424
Otoplasty (Ear surgery)           Standard fee -      $2,508

Rhinoplasty (open)                      Standard fee -      $3,428

            (closed)                    Standard fee -      $3,186

Rhinoplasty (Secondary) (open)          Standard fee -      $3,388

                        (closed)        Standard fee -      $3,232

(Suction-Assisted Lipectomy)
         for any single site            Standard fee -      $1,842
         ultrasound technique           Standard fee -      $2,304


Subject: E.6 Is there any visible scarring?

Any time a cut or incision is made in the skin, there is a scar left
behind as part of the normal healing process. Plastic and Reconstructive
Surgeons have received special training and have extensive experience with
minimizing the size of these scars, creating the least noticeable appearance
of then, and locating them in the least conspicuous areas possible. Often
the scars will become undetectable to all but the most careful examination
over the course of time.


Subject: E.7 - How long is a typical recovery period for most operations?

Generally, 1-2 weeks for most procedures, although this varies
from one patient to the next, as well as from one procedure to
the next.


Subject: E.8 - Will it be covered by my medical insurance?

In general, if it is cosmetic, your medical insurance will not cover the
surgery or treatment. (See the questions regarding the difference between
'plastic' and 'reconstructive' surgeries for more on this topic).


Subject: E.9 - How long does it take for an operation?

On an average, most surgeries take 2-3 hours in the operating
room, with the most extensive of multiple procedures lasting
several hours. Additional time is often required for preparation
before, and rest & recovery time after the surgery itself,
particularly when sedation or a general anesthetic is


Subject: E.10 - How long does it take to heal?

This varies greatly depending on the procedure in question. For
small, non-invasive procedures, such as laser tattoo removal,
or collagen therapy, patients are ready to return to normal
activity immediately after treatment. For procedures like laser
skin resurfacing or blepharoplasty, patients may be ready for most
normal activities in 3-6 days, while more extensive surgeries
such as abdominoplasty or extensive liposuction may require a
more extended convalescence.

The body's complete healing process takes longer than this initial
recovery time, and may last from several week up to a year or more
as incisions heal completely and tissues achieve their maximum


Subject: E.11 - What are the risks?

All surgeries entail risks, such as bleeding, possible infection,
etc. Please see the information on the specific surgery, or
consult with a qualified surgeon for more detailed information.


Subject: E.12 - Can you make me look like (insert name of favorite
celebrity here)?

Plastic surgery can achieve impressive results for a patient with
realistic expectations and goals. To many, the results may
even seem 'miraculous', however to think you can be made over so
completely as to look just like another person entirely is still
the stuff of Hollywood movies and fiction novels Cosmetic plastic
surgery's primary focus on refining a person's appearance,
rather than changing it entirely.


Subject: E.13 - What are the most common surgeries?

Among the most frequently performed surgeries are: breast
augmentation surgery, rhinoplasty, facelift and blepharoplasty
(eyelid surgery).


Subject: E.14 - What about the use of endoscopes in plastic surgery? Is
this just a sales tool? What is the advantage of using an Endoscope in
plastic surgery? What procedures are performed with it?

The endoscope is an instrument which allows the surgeon to
utilize a very small incision and still see the actual
surgical location deep under the tissues. This means that
a minimal scar in the axilla can be made, without compromising
the results of the surgery. To achieve an equivalent degree
of visibility and control without an endoscope, the surgeon would
need to make a larger incision in a more visible location.
For comparative purposes, this type of procedure is
similar in nature to orthoscopic surgeries that have become
popular in the media recently for joint surgeries on athletes.
This is not to say that a good result cannot be achieved without
an endoscope, but it is more challenging for the surgeon, who is
operating solely 'by feel'.






Can abdominoplasty eliminate the 'stretch marks' I have left from
after my pregnancy (or other weight gain)?



F.2.A.1 - I have heard about breast implants that use soy bean oil
          as the filler of the implant? Can you tell me more about this?

F.2.A.2 - Why textured vs. smooth implants for the breast implants? What
          is the difference? What are the advantages / disadvantages?

F.2.A.3 - What is the advantages / disadvantages of the (axillary / infra-
          mammary / peri-areolar) approach for breast augmentation?

F.2.A.4 - How much enlargement can I get? What is the maximum limit? What
          determines this limit?


F.2.A.5 - Will I be able to breast feed?

F.2.A.6 - Will my breasts be 'saggy'?

F.2.A.7 - Will my breasts become 'saggy' later on?

F.2.B.1 - Can plastic surgery correct inverted nipples? Can I
	  enlarge or reduce the size of my nipples?

F.2.B.2 - I have heard about breast augmentation through the belly
	  button. Can you tell me more about this?


F.3.A - I have heard the term 'laser eyelid surgery' or 'laser
        blepharoplasty' before. What does this mean? What is the
        difference between this and the other blepharoplasty?

F.3.B - Will having blepharoplasty affect how my contact lenses fit?


F.4.A - I have heard that some doctors can do nose surgery by
        making the incision inside the nose (where the scar is not
        visible). Why aren't all rhinoplasty surgeries done this way?


F.5.A - I have heard the phrase 'tumescent liposuction' used
        before. What does this mean?




Subject: F.1.A: - Can Abdominoplasty eliminate "stretch marks" from
                  my pregnancy?

If the stretch marks are located in the incision area for the
surgery (below the belly button) then they can be removed in
the course of abdominoplasty. In locations not at the incision,
site, they cannot be removed, although it is sometimes possible to
use a different incision location to accomplish this goal.

Surgery on just the stretch marks alone will merely trade the
stretch marks for an incision scar, and is a generally a poor
trade-off considering the cost and effort of surgery.



Subject: F.2.A.1 - I heard about soy bean oil / peanut oil /hydro gel
                   as a filler material for breast implants. What
                   are those?

Currently, only saline-filled implants are approved for general
use in the United States. There has been experimentation with
soybean oil, peanut oil, and hydro gel as fillers for breast
implants, but these are not approved for general use in the USA,
and it does not appear likely that any of these will be approved
for use in the foreseeable future.


Subject: F.2.A: - What is the difference between textured & smooth
                  breast implants? What are the advantages &
                  disadvantages of each?

Softness of the breast following augmentation, along with a
natural appearance, are primary concerns to both the surgeon and
the patient. The ideal result is one which is natural in all

Smooth implants are the softest implant immediately after
they are placed, but they require ongoing massage and
mobilizing by the patient to maintain this result. Additionally,
they may only be placed under muscle layer of the chest. In
nearly all patients, within a few years after the surgery,
the massaging becomes too inconvenient to continue, and as a
result, the breast will lose the softness that gives the most
natural result.

Textured implants are slightly more firm when initially
placed, however they require no special upkeep on the part of the
patient to maintain their softness. Additionally, they can
be placed either under or over the muscle layer (when appropriate
for some patients), which gives the surgeon more control to obtain
the best result for the patient. (see "How much can the breast be
enlarged?" for more information regarding placement under or
over the muscle layer). For this reason, the textured implants
are the preferred choice of many surgeons.


Subject: F.2.A.3 - What is the advantage of axillary approach
                   for breast augmentation?

The axillary approach has several advantages for most patients.
First, it does not invade the breast tissues directly, going
underneath instead. Secondly, there is no scar left on the skin of
the breast -- instead the scar is located in the armpit area,
which is a much less noticeable location. This is the preferred
approach for patients who have do not have pendulous (saggy)


Subject: F.2.A.4 - How much can my breasts be enlarged? What is 
		the limit of this? Why is it limited?

The degree of enlargement is based on the anatomy of the patient's
body more than any other factor. Saline-filled implants require
placement underneath the muscle layer of the chest to achieve
a natural result in most patients. The implant must be covered
by the muscle layer, and this coverage determines the maximum
volume of the implant.
The width of the patient's chest, as well as the locations of
nerves in the chest and abdomen limit the maximum volume of an
implant that can be used, because the total width of the implant
must fit underneath the muscle without intruding into the nerve
bundles, otherwise numbness of the breast and/or nipples would

For some patients, placement of the implant may be possible on
top of the muscle layer, providing they have a sufficient amount
of breast tissue and fatty tissue to give the implant the coverage
needed to achieve natural results. Your surgeon can help you
determine the best size of implant for you at the time of your



Subject: F.2.A.5 - Will I be able to breast feed?

Breast augmentation (under the muscle layer) should not affect your
ability to breast feed. For sub-glandular augmentation (under the
breast tissue, but over the muscle layer), like any other surgery
which disturbs the breast tissue itself, there is a risk of losing
the ability to breast feed.


Subject: F.2.A.6 - Will my breasts still be saggy?

Sagging of the breast is a factor determined by your body. Some
degree of sagging can be corrected with the breast augmentation
surgery, but not an excessive degree. For an excessive degree of
sagging, a mastopexy or 'breast lift' may be the solution.


Subject: F.2.A.7 - Will my breasts sag later?

Again, this is a factor of your body's makeup. In general, if
the factors which caused the sagging in the first place (heavy
breast tissue, lack of elasticity of the skin, etc), are still
present, then the breasts will again begin to sag over time.
If correcting this sagging is of primary importance to you, your
surgeon can discuss other alternative surgeries which may be done
instead of, or in addition to the breast augmentation procedure.


F.2.B.1 - Can plastic surgery correct inverted nipples? Can I 
	enlarge or reduce the size of my nipples?

The nipples can be reduced in size, or correction of 'inverted'
nipples can be done. This can be done along with breast
augmentation, or alone as a separate surgery.

With inverted nipples, the problem is that the ducts are short, plus the
connective tissue adherence participates. One very effective technique
to correct this is four small cuts around the nipple (division of the
ducts) and suture support. This heals quite quickly, a week to ten days,
and with this technique, recurrence is almost never seen. 


F.2.B.2 - I have heard about breast augmentation through the belly
	  button. Can you tell me more about this?

This type of procedure is called a 'trans-navel approach'.  An incision
is made in the umbilicus (belly button) area. An endoscope is placed
through this incision, and a tunnel is made to each breast. The implant
is placed by rolling it up in a tubular shape and then pushing it
through the endoscope to the breast where it is inflated. Pushing the
implant through the scope carries an increased risk of damage to the
implant, and I am told that implant manufacturers do NOT honor the
warranty if this method is used.  With the cost of implants
alone ranging from $1000 to $1500 this is a very important point. Other
comments from surgeons included a significant increase in the length of
the surgery (up to 2 hours, according to one surgeon), and a
signification reduction in the control of the placement of the implant,

A survey approximately 1 dozen reputable surgeons in a major city
showed that *none* of them perform this technique, including one
surgeon who had done the preocedure with this technique during his
surgical training and felt that the more conventional methods were very
much superior.




Subject F.3.A.1 - Regarding blepharoplasty, what methods are used?
                  What about  "laser blepharoplasty"? What's the

The conventional blepharoplasty utilizes an incision (with
creation of the eyelid fold if needed), removal of excessive
skin, muscle, and fatty tissue to provide the best, most
consistent, and longest-lasting result.

Removal of the skin only, without attention to the underlying
tissues achieves a smaller degree of correction, and is not as
long lasting.

"Laser" blepharoplasty is a combination of surgery and light
resurfacing of the skin, with no removal of the excessive
skin of the eyelid. This primarily treats the fatty tissue
deposits without removing excessive skin, so it is most effective
for younger patients. Older eyelids require removal of the
excessive skin to achieve the full benefit of the surgery.

F.3.B - Will having blepharoplasty affect how my contact lenses fit?

Blepharoplasty surgery only works on the skin and muscle of the eyelids
area -- how your contact lenses fit is based on the sahpe of your eye
itself. Although you won't be able to wear contact for the first few
days after surgery (to allow time for the healing process to begin
without disturbance) blepharoplasty surgery will not change how your
contact lenses fit or function.




Subject: F.4.A.1 - What about nose surgery from inside the nose?




Subject: F.5.A.1 - What is "tumescent" liposuction?

The tumescent technique is a relatively new liposuction method that
can reduce post operative bruising, swelling and pain. Also, blood
loss is minimized during tumescent liposuction due to the effects of the
local anesthetic which is used.

In the tumescent technique, areas of excess fat are injected with a
large amount of anesthetic liquid before liposuction is performed.
The liquid causes the compartments of fat to become swollen and firm
or "tumesced." The expanded fat compartments allow the liposuction
cannula to travel smoothly beneath the skin as the fat is removed. This
can give multiple benefits -- extra precision for the surgeon, reduced
loss of blood for the patient, and extended pain relief after surgery,
which can reduce the need for pain medication immediately after surgery.




F.99.A Penis Enlargement Surgery

	(Editor's note: although only a handful of specializing surgeons
perform this procedure, inquiries to plastic surgery office regarding
this procedure are frequent, therefore we include this for information

The most common surgical procedures for 'penis enlargement' utilize
cutting the ligaments which suspend the penis, which is designed to
lengthen the externally visible portions of the organ, and by injection
of fat or other graft or material to increase the width.

According to Mayo Clinic website information:


"in a vast majority of cases", retraction of scar tissue where the
ligament is cut eventually results in a *shorter*, rather than longer


injection of fat or other material usally results in a loss of natural
form and a "bumpy", "irregular shape"

The article goes on to say that data presented at an American Urological
Association meeting was met by an "appalled" response with what the
presenting surgeon called 'success'. (The surgeon in question
subsequently had his medical license suspsended and faced legal

A related article in _The Journal of Urology_ (Dec 1997) addresses
reconstruction of deformities resulting from these procedures. In part,
it references that the procedures used to attempt 'enlargement' of
normal organs are actually based on techniqeus developed to correct
abnormal deformities. The author goes on to say that, while not all
surgeries and techniques should be condemned based on a few faulty
techniques, but he also notes that frequnetly the patient was not
adequate informed of potential complications, and that correcting these
complications is difficult and often requires more than one procedure to
achieve an adequate reconstruction.

Additionally, it is noteworth that the American Urological Association
does not advocate or endorse these procedures:

            Policy Statement of American Urological Association
   American Urological Association, Inc.
   1120 N. Charles Street, Baltimore, Maryland 21201 o Phone 410-727-1100
   Penile Augmentation Surgery

   The American Urological Association (AUA) considers subcutaneous fat
   injection for increasing penile girth to be a procedure which has not
   been shown to be safe or efficacious. The AUA also considers the
   division of the suspensory ligament of the penis for increasing penile
   length in adults to be a procedure which has not been shown to be safe
   or efficacious. 

Board of Directors, January 1994 


What about implants for the buttocks?

What about cheekbone reduction?

What about chin reduction?

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