Leading dermatologist Dr. Joshua Fox urges

patient education and research before scheduling


New Hyde Park, New York, February 2009 – With nearly 12 million surgical and nonsurgical procedures performed in the United States in 2007, cosmetic surgery has become both big business and a mainstream part of American life. Many more Americans than ever before are seeking to improve their facial features, remove unflattering spots, flatten their tummies or expand their breasts. In fact, the American Society for Aesthetic Plastic Surgery says the overall number of cosmetic procedures has increased by more than 450 percent since it started collecting statistics in 1997.


But, warns Joshua L. Fox, M.D., a leading dermatologist and founder of Advanced Dermatology, PC, and The Center for Laser and Cosmetic Surgery, setting your sights too high and having false expectations can make the process and its results less than beautiful. Dr. Fox says patients considering surgical cosmetic procedures need to be well informed, have realistic expectations and avoid common mistakes…Or they may be disappointed. Following are nine misconceptions about cosmetic procedures:


1.  I’ll be in and out today. “While it’s true that many cosmetic procedures are done on an out-patient basis, that doesn’t mean that you’ll be in and out in a few hours and then done,” Dr. Fox says.  “Cosmetic surgery is just that — surgery — and you’ll probably be tired, sore and uncomfortable for several hours or even several days after you get home depending on the procedure, of course.”  Non-surgical cosmetic procedures, like Botox fillers, microdermabrasion, laser hair removal and some other laser procedures are quick, with minimal risk with the patient back to work in as soon as a few hours.

2. It will heal quickly.  Wounds may heal faster or more slowly depending on the type of procedure.  “Immediately following a surgery with cutting, your wound may be warm, red, swollen and tender while the healing begins,” Dr. Fox says. After a few days, he says, the wound may begin to look wet and white or yellow as the skin around the area thickens and the wound gets smaller. Finally, a slow process of “maturation” begins, as the wound gets stronger. This process can last from several weeks to much longer.

3. I will have no marks left.Patients undergoing cosmetic procedures want to improve their appearance and keep scarring to a minimum,” Dr. Fox says.  “As cosmetic surgeons, we work very hard to reduce scarring, but patients must take some of the responsibility by remembering that sun damage can slow or even prevent the healing and fading of scars.”  At the very least, he urges patients to initially keep scars out of the sun or protect them with sun block. “With correct care and protection after surgery, most scars fade and become barely noticeable.”  Other things patients must do include the following recommendations:

a)  follow all instructions carefully

 b)  avoid trauma or home remedies to the area;

c)  avoid smoking as it slows wound healing;

d)  use moist wound healing technique

e)  avoid potential allergens like Bacitracin®, Neosporin®,  or Polyporin®, unless infection is suspected.

4. There will be no discomfort. By its nature, cosmetic surgery is superficial and does not generally cause much swelling or bruising. However, any surgery carries with it the risk of discomfort or pain, swelling and other complications. The patient’s pain or discomfort, of course, will vary depending on their own threshold for pain.  There are many methods to reduce pain include a Zimmer cooler, ice packs, gating technique, better instrumentation, and buffering the local anesthetic.  Of course, if it is a larger procedure an anesthesiologist or a nerve block, as well as oral antianxiolytic and narcotics may be helpful.

5. It is safe/there won’t be any complications. While most cosmetic procedures and surgeries have predictable results and are very safe, it is important to remember that complications can arise whenever a procedure takes place. Cosmetic surgery complications, although rare, can range from scarring, infection, skin depression or discoloration to, even on rare occasions, fatalities.  The effects of surgery can sometimes be traumatizing to patients both physically and psychologically. “The risks of cosmetic surgery will differ depending on the individual and the procedure,” Dr. Fox says, “so make sure to ask your physician a lot of questions beforehand so that you will know what to expect and be able to minimize risks.”  “It is critical to ask your surgeon to explain what sort of recovery you will face, what complications may arise, and how you can reduce discomfort or pain,” Dr. Fox says.   Ask your doctor how to minimize risks.  For example, which medications may or may not be introduced during surgery and what you can do to lessen bruising.  Also, ask your medical doctor if you are healthy enough to have the procedure you are electing.  Choosing a cosmetic surgeon with a lot of experience also lowers the risk of complications.

6. The more procedures I get, the better I will look. “Again, it is important to remember that any surgery carries with it inherent risks and potential complications, and the more surgeries, the more risk.” According to Dr. Fox, some general risks, although rare, for cosmetic surgery include Some people feel the need to have cosmetic procedures when they look great – dubbed “cosmetic surgery junkies”.  A good cosmetic surgeon will tell you that nothing is required in that situation.

7. It won’t cost too much. Several factors determine the cost of cosmetic surgery,” Dr. Fox says, “including geographic location, the surgeon’s expertise, the number of areas treated, amount of time and effort required of the cosmetic surgeon and, in the case of a larger procedure, the cost of the anesthesiologist’s services as well as operating room and lab fees. Ask about all costs surrounding the surgery before you schedule it.”   Some practices will package the fees as one inclusive cost or may have their own out-patient surgery center – which may lower the total cost.

8.  I just need to fix this tiny spot. The most important thing to remember about any type of medical beauty procedure is that there is no way to completely eliminate the risk of complications, so if you’re looking to fix something tiny, you and your physician may be able to consider alternatives to surgery like laser or other spot treatments.”

9. All laser and cosmetic surgeons are equal.   As with any field, experience matters and can make all the difference between technique, expertise and knowledge.

Dr. Fox says that education and research are the keys to avoiding false expectations from cosmetic procedures. “One of the best ways to achieve your goals and at the same time limit your risk and assure a positive result of your cosmetic surgery is to educate yourself,” he says. “Do your homework before you schedule the first visit to a cosmetic surgeon, research each procedure and its inherent risks, look up your doctor and/or his website, and learn about your cosmetic surgeon’s background and experience. In addition, it is ideal to have a full medical checkup prior to embarking on major cosmetic surgery.

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