Dr. Dirk Lazarus
Plastic Surgeon

Tel: 021 424 1112
Fax: 021 424 1118

86 New Church St
Tamboerskloof
Cape Town, 8001
South Africa

The public loves plastic surgery, even if only to read about it in the popular press. Stories range from the speculative who-has-had-what-done to features on the usual suspects (is his nose really falling off this time?) Reports document revolutionary new medical breakthroughs (most often released by the PR agencies of unscrupulous surgeons and highlighting techniques well known to the plastic surgery community) or plastic surgery disasters (usually the patients of those same unscrupulous surgeons). From gargoyle to beauty queen, the headlines are legend.

But beyond the tabloid appeal plastic surgery is a multi-facetted surgical discipline. It is a medical specialty practiced by highly trained doctors. It is based on solid foundations, follows logical principles and is at the cutting edge of many exciting developments in medicine and health.

Plastic surgery is the fastest growing medical specialty in the US. Increasingly there is what I have heard called a Los Angelesation of the world. Almost everyone seems to want to look younger and more beautiful.

Popularised by Hollywood and the media, plastic surgery is no longer the domain of only the rich and famous. Now your neighbour's daughter might have had her breasts done, your colleague across the office his or her eyes, or the person in front of you in the supermarket queue may not be quite as young as s/he looks.

The American Society of Plastic Surgeons (ASPS) collects statistics on the number and type of procedures performed by its members, board certified plastic surgeons in the US. Between 1992 and 2001 the number of US citizens undergoing cosmetic plastic surgery by ASPS members tripled. The surge in cosmetic plastic surgery illustrates the increased willingness of Americans to incorporate plastic surgery into their health and beauty regimens.

The number of patients presenting for rejuvenation or other enhancements is usually reflective of the economy. In boom times, plastic surgeons do well. In the past year in the US, despite the first recession in a decade, the highest unemployment rate in seven years and a 7-year low in consumer confidence, the number of patients having procedures increased seven percent to 7.5 million.

"These statistics show that cosmetic plastic surgery has moved beyond the notion of being an exclusive privilege of the rich and famous," noted ASPS President, Edward Luce, MD. "Even in a difficult year economically with a recession intensified by the terrible events of September 11, people continued to consider plastic surgery as a reasonable option to feel better about themselves, enhance their appearance or minimize signs of aging."
But plastic surgery is not just about restoring youthful good looks and creating harmonious beauty. The 'plastic' in plastic surgery is not because of plastic bits that are inserted. It is derived from the Greek word plastikos, meaning to mould or to shape.

The specialty of plastic surgery includes cosmetic surgery and reconstructive surgery. Reconstructive surgery is to restore normal form and function, perhaps in a child born with a congenital deformity, a victim of trauma or a patient mutilated by cancer. Many plastic surgeons cut their teeth (?scalpels) on reconstructive cases. Most still actively enjoy performing this type of surgery.

Cosmetic surgery is to enhance normal, to improve it, to make more beautiful or to make younger. Frequently techniques used for cosmetic surgery are transplanted to reconstructive surgery, for example fat transfers, which have become an inevitable component of my facelifts, are now used to enhance the repaired lips in my cleft lip patients. Similarly when I lift a drooped brow, whether it is due to age or to a traumatised facial nerve, the procedure is the same. The cross over is essential and mutually beneficial. Were it not for the cosmetic surgery cases, I would not have the freedom to practice reconstructive surgery. Practicing reconstructive surgery enhances my skills and allows me to be a better cosmetic surgeon.

Whether reconstructive or cosmetic, plastic surgery is about improving form and function. When you look good you feel good. A surgical procedure can enhance your self esteem and increase your self confidence.

I had a patient once who had a rhinophyma, a condition of the nose in which it enlarges. His nose was so big that he lived as a recluse, only going out to do his shopping at night and then with his nose hidden in a bag or behind a bandana. In a simple operation we shaved off the excess tissue, restored his nose to a normal size and allowed him to live a normal life.

Clearly this is an extreme case, but the principle remains the same: people feel better when they look better. Society places an enormous emphasis on looks. Studies have shown that better looking people earn more, are promoted sooner and are more likely to occupy senior positions within corporations. Given the same qualifications, the more attractive person, male or female, is more likely to get the job. Similarly, when it comes to choosing a partner or mate, do looks count?

So when you look better, you feel better. Your productivity is likely to go up and perhaps you become a more valuable member of society. If you look like a million bucks, are you worth a million bucks?

I am sure that given the correct tools and a big enough computer, the actuaries could tell us what the impact of cosmetic surgery is on our economy. But the medical aid schemes who employ them just do not want to know. Medical aids in South Africa do not cover cosmetic surgery. In fact some medical aids do not even cover some forms of reconstructive surgery such as breast reconstruction. Clearly they see no value in replacing a breast that a woman has lost to cancer. But then the medical aids in this country are more intent on healthy profits than a healthy populace. And health economics is still a primitive science.

Patients however do recognise the value of cosmetic surgery. They recognise that when they look good, they feel better. They are prepared to pay for this and sometimes substantially so. They recognise the health benefits, even if cosmetic surgery is still a luxury item.

These days the consumer can choose what to do with his hard earned dosh: fork out for the new kitchen appliance, take the holiday in Bazaruto, or go for the snip, nip and tuck to take 10 years off their face.

These days more people are opting to look better and to look younger. As mentioned earlier, 7.5 million Americans elected to undergo cosmetic surgery in 2001. 87% of these patients were women. The big five surgical procedures were: nose reshaping, liposuction, eyelid surgery, breast augmentation and facelift. Common non-surgical procedures were skin resurfacings, Botox injections and the injection of filler materials. Plastic surgery is healthy and creating healthy patients. The public know this.