September 18, 2006
FIRST PERSON: Make me pretty | A plastic surgeon discusses the hottest cosmetic procedures in Maine, the dangers of lunch-hour facelifts and his most unusual referrals. Iguana bites, anyone?
By Steven Bonawitz
Northeast Plastic Surgery, Lewiston
I've enjoyed practicing in the state of Maine. It's a very busy place to practice, and that's something that a lot of people are surprised to hear. They don't think of Maine being a place where you're going to find plastic surgeons, but there's always a lot to do here.
If there is an average day, I spend about half my time in the operating room and about half my time in the office. Some plastic surgeons have office surgery centers where they do a lot of their work, and some plastic surgeons work primarily out of hospitals. I work at both local hospitals, Central Maine Medical Center and St. Mary's Regional Medical Center.
I see a variety of people with a variety of problems. Some want to look better, some are people with injuries or deformities, problems as a result of disease, trauma ˆ things of that nature. There's usually a tremendous variety that most plastic surgeons see.
I do a fair amount of cosmetic surgery; it's more than half of my overall practice.
There's more cosmetic breast surgery than anything else, definitely. Probably breast augmentations are number one ˆ breast lifts, breast reductions ˆ and then abdominoplasties and liposuctions. Abdominoplasty is a tummy tuck. It seems there's a little bit less of a demand for facelifts, brow lifts, buttock lifts and calf augmentations. Things of that nature just don't seem to be quite as popular in this area as they might be in, say, Miami or Los Angeles. New England is a very conservative area in general.
Generally, for a breast augmentation, the prices are roughly in the range of $5,000 to $5,500 in the state of Maine. There are parts of the country where it's less expensive and parts of the country where it's more ˆ just as with anything else, there can be big regional variations on any commodity you buy. And that's true in general with medical costs. It has to do with what people can afford to pay, with practice costs in a given area of the country. Surgeons don't sit around and discuss setting fees, but we're all vaguely aware of what goes on in a given area. You have patients who come in and tell you what the guy down the street charges, so you know in general if what you charge is within the range of what other people charge.
In certain areas of the country, plastic surgery seems to be much more popular. There's just a lot more of it being done in certain areas. Overall, plastic surgeons have noticed over time that in southern parts of the country and in major cities people are more interested in plastic surgery.
In Maine, though, I believe some of those differences are changing. People in Maine are very well connected. Particularly with cable TV and the Internet, people become aware of styles and fashions, and a lot is driven by trends and what people see and what they'd like to see in themselves. It has a lot to do with self-image. I think we're starting to catch up in some respects.
The trouble with TV
I think that most plastic surgeons would tell you that shows like Nip/Tuck are not representative of [the industry]. Those shows are very sensationalistic; they're designed to get people's attention. They're kind of like soap operas, and they're very effective at that. I think we'd all emphasize that plastic surgery is a lot more serious.
The same is true with the extreme makeover shows. While the procedures done in those shows are definitely good procedures ˆ and to my knowledge the surgeons on those shows seem to be good surgeons ˆ most of us would approach multiple procedures of that nature with extreme caution. The emphasis is always on patient safety more than anything else.
There are some aspects of these shows that are a little bit unrealistic, but on the other hand these shows have, in my opinion, made people more comfortable considering cosmetic surgery and more likely to look into the option of a cosmetic surgical procedure. I would always emphasize the most important first step in someone considering a procedure is to always seek out a qualified plastic surgeon to discuss these issues.
These days, the patient is seen as a consumer. It's very important for patients to be fully informed about what their options are, and for them to be participants in the decision-making process. The initial consultation is a discussion and review of a patient's past medical history to understand what other issues the patient might have. It's important to understand why the patient is there, what it is they're unhappy with and what they would like to see.
I discuss the options and discuss the procedures ˆ it usually narrows down to a procedure or perhaps a couple of options. And while the patient needs to be involved in the decision making, the plastic surgeon brings to the conversation a knowledge of what will or will not work. And sometimes people see things and hear things from friends, look things up on the Internet or catch things on advertisements. People will oftentimes come in asking for procedures that won't really work for them and won't have the desired outcome.
For instance, liposuction works very well for patients that simply have excess fat and have good elasticity of their skin. For patients who have very stretched out and damaged skin, oftentimes liposuction won't have the desired effect. It won't correct a hanging fold of skin, and for some individuals, liposuction could have a very poor outcome. Same with breast augmentation. Patients who are very stretched out ˆ oftentimes women who have had children and have breast fed have a lot of sagging. And if there is a lot of sagging in the breasts, placement of implants alone often is not going to have very good results.
People also hear about minimal procedures. It's been very popular in the last 10 years or so for people to advertise things for skin rejuvenation ˆ creams, lasers and other forms of skin rejuvenation. I don't want to use specifics, but they're often tagged with very catchy phrases and names, and they'll sound like they are an alternative to plastic surgery. For example, you hear people talking about the lunch-hour facelift. But in the end, if a person needs a facelift, they need a facelift. And a lunch-hour facelift-type procedure is not very likely, for most patients, to have the same effect. That's why it's important for patients to understand these options, but also to come in and talk to an experienced plastic surgeon who can tell them what's likely to work.
I've talked people out of getting a procedure many times. There are, in my opinion, individuals who may not be a good candidate for a procedure. I tend to be extremely conservative. It's not just about taking somebody's money and doing something to them; it's about trying to figure out if the procedure is going to work for them.
That can be very difficult. There are some people who don't comprehend the procedures, and some people that may ask you to do things that either you're not trained in, or you're not comfortable with or you don't believe will help them. For example, I've had some very young women, teenagers under the age of 18, who want breast augmentation. I basically avoid doing breast augmentation in patients who are minors. And it's not uncommon for them to come in with their parents, and they will tell me ˆ and their parents will confirm ˆ that they've thought this over very carefully. They've wanted this for a long time and they're very certain about it. In that instance, I generally will advise them that if they truly want it that badly, then they'll still want it in a couple of years.
Every surgical procedure is very serious. Every operation can leave effects that can last the rest of your life, and some of them can be untoward effects. That's why we generally try to avoid doing cosmetic procedures in minors. It's important that they have the capability to make a decision regarding their body, especially with a decision that could leave them with a permanent scar or deformity.
ATV accidents, bar fights and other trauma
It certainly seems that we almost hibernate in Maine as the winter approaches. This time of year, people are going back to school, the holidays are approaching and people's minds are in other things. But as we get into the winter and get past the holidays, people start thinking about spring and about the summertime again. And, mentally, people start thinking about spring and summer and bathing suits. I think taxes have a lot to do with it. We fill out our tax return forms and we start thinking about getting that money back and what we're going to do with it. It's funny ˆ right about mid-February and March, you start to see a sudden upswing in the number of calls as people are thinking about these things.
It has a lot to do with the economy, of course. That can really affect things. Cosmetic surgery is a luxury purchase. It's something you do when you have money to spend. Most surgeons have noticed over the last year or so that there's been a little bit of a downward trend with the rise in gas prices and an uneasiness about the economy. But as soon as things relax a little bit, it all comes back.
When I came out of practice [in Michigan] and started to consider where I was going to settle down, I knew that I liked the Northeast in general, and I had been to Maine before. I started to look at the New England area and I found Maine as a place where there are some plastic surgeons, but they're fairly concentrated. There was this whole Lewiston area where there were a lot of people, there were good hospitals and there was no one who was doing this type of work here.
In Maine, people are active. People enjoy activities such as motorcycle riding, snowmobiles, outdoor activities, water sports ˆ things of that nature. We also have other people come to the state for these reasons. So there are a lot of people in Maine that are exposed to potential trauma. We have a busy trauma center here in Lewiston, where people are brought in from a fairly large surrounding area.
I think most plastic surgeons that do facial trauma will tell you that seat belts and air bags in particular probably are decreasing serious facial injuries following motor vehicle accidents. There are still people who don't put their seat belts on, but we seem to be seeing less of the major facial injuries. We see a lot of ATV and motorcycle trauma in this state. ATVs are fairly dangerous vehicles.
But what we tend to see more is low-velocity-type facial trauma ˆ which is commonly people beating each other up. Every area has its bars and people who will go out and get a little uninhibited.
Unusual things often get referred to plastic surgeons. If it leaves a physical wound, they'll see a plastic surgeon. I've seen iguana bites, horse bites. Moose are really tall creatures, and when you hit them they tend to come into your windshield, and they cause pretty devastating injuries.
Unfortunately, in a lot of vehicular trauma and a lot of the fights we see, a disproportionately high percentage of that is among individuals that have no insurance. There's also a correlation between that and alcohol and drug use. It's a very important issue right now in specialty trauma care overall, from plastic surgeons to neurosurgeons. That's especially true in states like Maine, where you don't have large cities that have lots of doctors. Cities like Baltimore or New York or Boston attract lots of surgeons and lots of specialists. It's not too hard for hospitals to find people to cover their schedules. Places like Maine tend to attract fewer specialists and it can be somewhat difficult to find specialty care in certain areas.
It's very expensive, especially to run a private practice, and it's a lot more difficult than people realize. I think anyone who's trained to become a doctor, we've all trained to help people. I can't think of anybody who went through medical school just to make a lot of money. We all go into it to try to help people.
I've enjoyed practicing in the state of Maine. It's a very busy place to practice, and that's something that a lot of people are surprised to hear. They don't think of Maine being a place where you're going to find plastic surgeons, but there's always a lot to do here.
If there is an average day, I spend about half my time in the operating room and about half my time in the office. Some plastic surgeons have office surgery centers where they do a lot of their work, and some plastic surgeons work primarily out of hospitals. I work at both local hospitals, Central Maine Medical Center and St. Mary's Regional Medical Center.
I see a variety of people with a variety of problems. Some want to look better, some are people with injuries or deformities, problems as a result of disease, trauma ˆ things of that nature. There's usually a tremendous variety that most plastic surgeons see.
I do a fair amount of cosmetic surgery; it's more than half of my overall practice.
There's more cosmetic breast surgery than anything else, definitely. Probably breast augmentations are number one ˆ breast lifts, breast reductions ˆ and then abdominoplasties and liposuctions. Abdominoplasty is a tummy tuck. It seems there's a little bit less of a demand for facelifts, brow lifts, buttock lifts and calf augmentations. Things of that nature just don't seem to be quite as popular in this area as they might be in, say, Miami or Los Angeles. New England is a very conservative area in general.
Generally, for a breast augmentation, the prices are roughly in the range of $5,000 to $5,500 in the state of Maine. There are parts of the country where it's less expensive and parts of the country where it's more ˆ just as with anything else, there can be big regional variations on any commodity you buy. And that's true in general with medical costs. It has to do with what people can afford to pay, with practice costs in a given area of the country. Surgeons don't sit around and discuss setting fees, but we're all vaguely aware of what goes on in a given area. You have patients who come in and tell you what the guy down the street charges, so you know in general if what you charge is within the range of what other people charge.
In certain areas of the country, plastic surgery seems to be much more popular. There's just a lot more of it being done in certain areas. Overall, plastic surgeons have noticed over time that in southern parts of the country and in major cities people are more interested in plastic surgery.
In Maine, though, I believe some of those differences are changing. People in Maine are very well connected. Particularly with cable TV and the Internet, people become aware of styles and fashions, and a lot is driven by trends and what people see and what they'd like to see in themselves. It has a lot to do with self-image. I think we're starting to catch up in some respects.
The trouble with TV
I think that most plastic surgeons would tell you that shows like Nip/Tuck are not representative of [the industry]. Those shows are very sensationalistic; they're designed to get people's attention. They're kind of like soap operas, and they're very effective at that. I think we'd all emphasize that plastic surgery is a lot more serious.
The same is true with the extreme makeover shows. While the procedures done in those shows are definitely good procedures ˆ and to my knowledge the surgeons on those shows seem to be good surgeons ˆ most of us would approach multiple procedures of that nature with extreme caution. The emphasis is always on patient safety more than anything else.
There are some aspects of these shows that are a little bit unrealistic, but on the other hand these shows have, in my opinion, made people more comfortable considering cosmetic surgery and more likely to look into the option of a cosmetic surgical procedure. I would always emphasize the most important first step in someone considering a procedure is to always seek out a qualified plastic surgeon to discuss these issues.
These days, the patient is seen as a consumer. It's very important for patients to be fully informed about what their options are, and for them to be participants in the decision-making process. The initial consultation is a discussion and review of a patient's past medical history to understand what other issues the patient might have. It's important to understand why the patient is there, what it is they're unhappy with and what they would like to see.
I discuss the options and discuss the procedures ˆ it usually narrows down to a procedure or perhaps a couple of options. And while the patient needs to be involved in the decision making, the plastic surgeon brings to the conversation a knowledge of what will or will not work. And sometimes people see things and hear things from friends, look things up on the Internet or catch things on advertisements. People will oftentimes come in asking for procedures that won't really work for them and won't have the desired outcome.
For instance, liposuction works very well for patients that simply have excess fat and have good elasticity of their skin. For patients who have very stretched out and damaged skin, oftentimes liposuction won't have the desired effect. It won't correct a hanging fold of skin, and for some individuals, liposuction could have a very poor outcome. Same with breast augmentation. Patients who are very stretched out ˆ oftentimes women who have had children and have breast fed have a lot of sagging. And if there is a lot of sagging in the breasts, placement of implants alone often is not going to have very good results.
People also hear about minimal procedures. It's been very popular in the last 10 years or so for people to advertise things for skin rejuvenation ˆ creams, lasers and other forms of skin rejuvenation. I don't want to use specifics, but they're often tagged with very catchy phrases and names, and they'll sound like they are an alternative to plastic surgery. For example, you hear people talking about the lunch-hour facelift. But in the end, if a person needs a facelift, they need a facelift. And a lunch-hour facelift-type procedure is not very likely, for most patients, to have the same effect. That's why it's important for patients to understand these options, but also to come in and talk to an experienced plastic surgeon who can tell them what's likely to work.
I've talked people out of getting a procedure many times. There are, in my opinion, individuals who may not be a good candidate for a procedure. I tend to be extremely conservative. It's not just about taking somebody's money and doing something to them; it's about trying to figure out if the procedure is going to work for them.
That can be very difficult. There are some people who don't comprehend the procedures, and some people that may ask you to do things that either you're not trained in, or you're not comfortable with or you don't believe will help them. For example, I've had some very young women, teenagers under the age of 18, who want breast augmentation. I basically avoid doing breast augmentation in patients who are minors. And it's not uncommon for them to come in with their parents, and they will tell me ˆ and their parents will confirm ˆ that they've thought this over very carefully. They've wanted this for a long time and they're very certain about it. In that instance, I generally will advise them that if they truly want it that badly, then they'll still want it in a couple of years.
Every surgical procedure is very serious. Every operation can leave effects that can last the rest of your life, and some of them can be untoward effects. That's why we generally try to avoid doing cosmetic procedures in minors. It's important that they have the capability to make a decision regarding their body, especially with a decision that could leave them with a permanent scar or deformity.
ATV accidents, bar fights and other trauma
It certainly seems that we almost hibernate in Maine as the winter approaches. This time of year, people are going back to school, the holidays are approaching and people's minds are in other things. But as we get into the winter and get past the holidays, people start thinking about spring and about the summertime again. And, mentally, people start thinking about spring and summer and bathing suits. I think taxes have a lot to do with it. We fill out our tax return forms and we start thinking about getting that money back and what we're going to do with it. It's funny ˆ right about mid-February and March, you start to see a sudden upswing in the number of calls as people are thinking about these things.
It has a lot to do with the economy, of course. That can really affect things. Cosmetic surgery is a luxury purchase. It's something you do when you have money to spend. Most surgeons have noticed over the last year or so that there's been a little bit of a downward trend with the rise in gas prices and an uneasiness about the economy. But as soon as things relax a little bit, it all comes back.
When I came out of practice [in Michigan] and started to consider where I was going to settle down, I knew that I liked the Northeast in general, and I had been to Maine before. I started to look at the New England area and I found Maine as a place where there are some plastic surgeons, but they're fairly concentrated. There was this whole Lewiston area where there were a lot of people, there were good hospitals and there was no one who was doing this type of work here.
In Maine, people are active. People enjoy activities such as motorcycle riding, snowmobiles, outdoor activities, water sports ˆ things of that nature. We also have other people come to the state for these reasons. So there are a lot of people in Maine that are exposed to potential trauma. We have a busy trauma center here in Lewiston, where people are brought in from a fairly large surrounding area.
I think most plastic surgeons that do facial trauma will tell you that seat belts and air bags in particular probably are decreasing serious facial injuries following motor vehicle accidents. There are still people who don't put their seat belts on, but we seem to be seeing less of the major facial injuries. We see a lot of ATV and motorcycle trauma in this state. ATVs are fairly dangerous vehicles.
But what we tend to see more is low-velocity-type facial trauma ˆ which is commonly people beating each other up. Every area has its bars and people who will go out and get a little uninhibited.
Unusual things often get referred to plastic surgeons. If it leaves a physical wound, they'll see a plastic surgeon. I've seen iguana bites, horse bites. Moose are really tall creatures, and when you hit them they tend to come into your windshield, and they cause pretty devastating injuries.
Unfortunately, in a lot of vehicular trauma and a lot of the fights we see, a disproportionately high percentage of that is among individuals that have no insurance. There's also a correlation between that and alcohol and drug use. It's a very important issue right now in specialty trauma care overall, from plastic surgeons to neurosurgeons. That's especially true in states like Maine, where you don't have large cities that have lots of doctors. Cities like Baltimore or New York or Boston attract lots of surgeons and lots of specialists. It's not too hard for hospitals to find people to cover their schedules. Places like Maine tend to attract fewer specialists and it can be somewhat difficult to find specialty care in certain areas.
It's very expensive, especially to run a private practice, and it's a lot more difficult than people realize. I think anyone who's trained to become a doctor, we've all trained to help people. I can't think of anybody who went through medical school just to make a lot of money. We all go into it to try to help people.
Most Recent
Most Recent
Comments