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A look at Plastic Surgery

Aired October 30, 2004 - 08:30   ET


ELIZABETH COHEN, HOST: Good morning, and welcome to HOUSECALL. I'm Elizabeth Cohen in for Dr. Sanjay Gupta.
Checking medical headlines, Chief Justice William Rehnquist is expected to return to work Monday. He was hospitalized last week for thyroid cancer and underwent throat surgery related to that.

And the first artificial spinal disk has been approved by the FDA. The metal and plastic implant can treat severe lower back pain by replacing a damaged natural disk. The new disc is an alternative to fusion surgery, which relieves the pain, but can restrict patient's mobility.

And Americans are getting taller and heavier according to a government report out this week. Americans are about one inch taller than in the early 1960s and 25 pounds heavier. The reason? Fast food, more television, and less walking, among other things.

Now to our top story. More Americans than ever before are heading to plastic surgeons for a little nip and tuck, from tummy tucks and breast lifts, to the increasingly popular liposuction. We followed one woman's quest to turn back the hands of time and be healthier in the process.


COHEN (voice-over): She wants a little off here, some out of here, too, and don't forget the back. Liposuction may have had a bit of a bad name for awhile, but it's back and recently took over breast augmentation as the most popular plastic surgery procedure on the body for women.

Sarah Alexander gave herself liposuction as a birthday present. She lost 20 pounds on her own, but it wasn't quite enough.

SARAH ALEXANDER, LIPOSUCTION PATIENT: I was starting to turn 40, and I was beginning to feel a little depressed about that, not to mention the weight that came along with turning 40.

COHEN: Now after liposuction with the Dr. Miles Gravier...

ALEXANDER: He's made me feel like I can fit in with the 20 somethings, the 30 somethings.

COHEN: Dr. Gravier tells Sarah she's still going to need to eat right and exercise after the surgery. MILES GRAVIER, DR., PLASTIC SURGEON: Because if they really cooperate and change the way they approach their lifestyle, then they're really going to have a great result, not just a good result.

COHEN: Liposuction can be something of an art form.

DAVID AURON, COSMETIC SURGEON: It's really not about just sucking fat out. It's about creating balance and proportion to an individual.

COHEN: And that's one reason you want to go to a plastic surgeon who does them often. The other reason? Done the wrong way, a doctor can actually make someone look worse.

BRIAN KINNEY, M.D., PLASTIC SURGEON: If you suction aggressively in that area of cellulite, you can actually accentuate the dips and it can be a problem.

COHEN: And worse, some people have died while getting lipo. One reason is that if a doctor takes out too much, the fluid shift could send the patient into shock.

In the 1990s, that was more of a problem. Now doctors are more cautious. This is Sarah's second liposuction because she wanted quite a bit removed. After her second procedure, Sarah liked the way she looked.


COHEN: And vows to continue to diet and exercise to make sure the fat doesn't come back.


COHEN: Liposuction ranks number two on the list of most popular cosmetic surgical procedures. Number one, the nose job. Filling out the top five, breast augmentation, then eyelid surgery, and facelifts.

In this week's installment of our "Body Works" series, we're talking about cosmetic surgery below the neck. Joining us to answer all of our questions is Dr. Nolan Carve, a plastic surgeon in New York City and associate professor of surgery at New York University School of Medicine. Welcome, Dr. Karp.

NOLAN KARP, DR., NYU MEDICAL SCHOOL: Good morning, Elizabeth.

COHEN: Good morning. Doctor, is liposuction a weight loss tool?

KARP: No, liposuction is not a procedure for weight loss or body reduction. Liposuction is really a procedure to shape the body. The ideal patient for liposuction is somebody who's at a good weight or a stable weight for themselves, who comes in with areas of the body that are bothering them or disproportionate, and that they would like to have improved.

COHEN: Well, we've got a question from Joan in Georgia who writes, "I've heard following liposuction fat returns, but to a different area of the body. Is this true? Also, are there alternatives to liposuction that will reduce the appearance of cellulite, mesotherapy for example?"

Doctor, let's start with the first part of that question. Is it true that if you gain weight after lipo, you'll just get bigger somewhere else? For example, we have a picture of a woman who had liposuction on her thighs and on her rear end. If in the months or years to come she gains weight, where is that weight going to go?

KARP: Well, we don't know where it's going to go, but if you gain weight after liposuction, the fat is going to go somewhere. And it usually goes somewhere where you don't want it to go. And the result can be sort of very unhappy for the patient.

COHEN: Another question now. Angela in Texas wants to know, "is there a point where you're too big for liposuction?" Well, Angela, the ideal liposuction patient is healthy with a consistent body weight and good skin elasticity.

Doctor, can someone be too big for liposuction?

KARP: Absolutely. Liposuction is not a procedure for the obese or the overweight. As we said before, the ideal patient is somebody who's at a good weight and has areas of the body that they'd like to have improved.

COHEN: Let's get to a question now from Monique in Massachusetts. "I'm 29 with two children. I'm considering a couple of procedures for my body, but the most important one to me is an inner thigh lift. Is there such a thing?"

Doctor, is there such a thing as an inner thigh lift?

KARP: Absolutely. Inner thigh lift is one of the procedures that we have available in our body contouring armamentarium. Unfortunately, it is one of the least successful procedures that we have.

The risk of relapse, the skin dropping is fairly high. And there's a high rate of patient dissatisfaction. So it's not a procedure that we perform often. In a new group of patients, the massive weight loss patients, we're finding though that an inner thigh seems to work better and is much more successful.

COHEN: So what would be an alternative then if you're concerned about sagging inner thighs?

KARP: You might consider liposuction.

COHEN: And that usually will take care of it?

KARP: Well, it will certainly take care of the extra fat, but it won't take care of the loose skin.

COHEN: Well, we'll be taking more of your e-mails coming up on HOUSECALL. Stay tuned.

ANNOUNCER: From breast implants to lifts and reductions, how safe are these surgeries and what can you expect?


UNIDENTIFIED FEMALE: Celebrities are no different than the rest of us. And everybody basically wants a quick fix.

ANNOUNCER: What are those famous faces and bodies doing to stay in shape? That's coming up later.

First, take today's "Daily Dose" quiz. What is the most common plastic surgery of the body for teenagers?


ANNOUNCER: Checking the "Daily Dose" quiz, we asked what is the most common plastic surgery of the body for teenagers? The answer -- breast augmentation, which increased nearly 25 percent last year in those 18 and younger.

COHEN: While teenagers are a small percentage of plastic surgery patients, kids age 18 and under are having some pretty grown-up surgeries. The top five are nose jobs and ear surgeries, then below the neck, breast augmentation, breast reduction in men, and liposuction.

Dr. Nolan Karp has done thousands of surgeries on teens, as well as adults. He's here to answer all of our questions about plastic surgery.

Dr. Karp, I'm curious, is there an age when - at which you just say you know what? You're just too young to perform certain surgeries?

KARP: Well, you know, I think you want the patient to be old enough to participate in the decision to go ahead with the surgery. So generally speaking, I think later teens seems to work better than earlier teens.

Now when it comes to breast augmentation surgery, you're putting an implant in the patient that may be in the patient for the rest of their lives. So I think they need to be old enough and spend some time thinking about the procedure before you go ahead to do it. So I would say 17 or 18 is kind of the bottom limit.

COHEN: Well, more than a quarter of a million women underwent breast augmentation last year. We've got a question about that.

Kimberly in Georgia wants to know, excuse me, "Is there an age that's considered too old for breast implants or augmentation?" Doctor, we were just talking about being too young. Can you be too old for that kind of breast surgery?

KARP: Not really. You know, when a patient comes in, regardless of the age, we look at the patient, we do a history, we do a physical examination, and we decide if they're healthy and a safe candidate for the surgical procedure. And I don't really have an upper age limit for any procedure, including breast implants or breast augmentation.

Naturally, body contouring surgery is much more common in younger patients, but we do do this surgery in older patients, patients who might be considered senior citizens.

COHEN: Well, we have another question now from Lauren in Pennsylvania who wants to know, "What is the best type of breast implant to get if you want a natural look?"

Doctor, the FDA refused to reapprove silicone implants earlier this year. So what are Lauren's options?

KARP: Well, silicone implants as you mentioned really are the most natural feeling and looking implants, but we don't have those available for breast augmentations. So generally what is done is a saline-filled implant with a smooth outer surface that is placed underneath the pectoralis muscle. And this gives a natural looking and feeling augmentation for the patient.

COHEN: And is that what most doctors are doing these days?

KARP: I would say the vast majority.

COHEN: Well, we sent our cameras out to find out what people were asking. Let's take a listen.


UNIDENTIFIED FEMALE: Is it possible to have your breast lifted without having implants?


COHEN: Doctor, what do you think about that?

KARP: Absolutely. If a woman is happy with the size of her breast, she doesn't need an implant. So basically, the breast lift operation lifts the breast, and creates a normal appearing breast.

Now we can offer this procedure to patients with a short scar today that gives them a lasting result and shorter scars. And it's actually much better than the longer scar procedures that we did in the past.

COHEN: Well, doctor, you were just talking about scars. We actually have a picture of what scarring can happen with this kind of surgery. And it's pretty extensive. It's those black lines you're talking about there. But you were saying you can make the scars shorter.

KARP: Absolutely. You just showed on this current graphic, the scars are -- you've eliminated the scar underneath the breast and you just have the scar around the nipple and the vertical scar. The scar underneath the breast is actually the longest scar. It's the scar that's the most visible, particularly in bathing suits and particularly if you're wearing a dress that's open in the middle. And so eliminating the scar underneath the breast really is a big help for the patients.

COHEN: Right. So you're getting rid of the horizontal line that we saw under there?

KARP: Correct.

COHEN: Now any kind of breast surgery, whether it's reduction or implants or lifts, can that interfere with breast feeding?

KARP: They can interfere with breast feeding. Studies have shown that patients that have breast surgery may have decreased ability to breast feed, but the number of patients who can breast feed is not much less in these patients. The ability for a woman to feed a baby completely can be less particularly in breast reduction surgery.

COHEN: Well we've got time for another quick question. Luis from New Jersey writes, "What scarring is associated with male breast reduction, especially in the case of excess extra skin under the breasts?"

Doctor, you brought us some images of breast reduction in men. We usually don't think of this surgery as being performed in men.

KARP: Well, correct. Let me go over the breast reduction surgery in men a little bit. The goal of breast reduction surgery in men is for the man to be able to walk around with his shirt off at the beach, poolside in the summer, go to the gym, and do things that men normally do. So you want to do this surgery with the absolute minimum of scarring.

Now this patient's a patient who came in. And on the left, you can see that he has enlarged breasts that he was unhappy with. And we performed a liposuction procedure through tiny incisions and were able to achieve the result on the right, which he was very happy with.

COHEN: Well, when HOUSECALL returns, does your tummy need tucking? We'll show you what to expect after the break.

ANNOUNCER: Are those makeover reality shows reflecting reality? Or encouraging unrealistic expectations? That's coming up.

But first, more of this week's medical headlines in "The Pulse."


HOLLY FIRFER, CNN CORRESPONDENT (voice-over): Illinois Governor Rod Blagoyavich asked the FDA to allow his state to purchase more flu vaccine from Europe. The vaccine would come from a factory in France owned by Aventis Pasteur, one of the makers of this year's U.S. flu vaccine.

The FDA said they will review the governor's request expeditiously, but they would first have to ensure that the vaccine is safe.

And cruise ship living may be a cost effective alternative to nursing homes for seniors, says a new stuffy from Northwestern University. The study found that the cost of living on a ship and that of living in a nursing home were relatively similar. And for those seniors who enjoy traveling, cruising may be a good option.

Researchers caution, however, that long term assisted living on cruise ships is not yet a reality. And it's not clear how insurance companies would handle this.

Holly Firfer, CNN.



COHEN: Welcome back to HOUSECALL. We're talking about plastic surgery this morning with Dr. Nolan Karp, a plastic surgeon in Manhattan and associate professor at NYU Medical School.

Dr. Karp, the fascination with plastic surgery and America's quest to look younger, as you know, has spawned some very popular shows from Fox's "The Swan" and MTV's "I Want a Famous Face" to "Extreme Makeover" on ABC.


ANNOUNCER: Patient surgeries Heather received. Hair restoration, a chin implant, a mini facelift with next scar revision. She had lipo sculpting of her hips, back, abs, and thighs. The excess skin from her arms and back was removed. And she had her breasts reconstructed.


COHEN: Wow! Doctor, do you think these programs showing sometimes eight or more procedures on one person, do they raise patients' expectations too high? Do your patients say hey, doctor, make me look like the people on those shows?

KARP: Absolutely. It's not only the number of procedures that are done, but it's also all the other things that are done. The patients get dental work. They get their hair done. Their skin is treated. They're seen by nutritionists. They're put in a gym and asked to work out for two months. And then in the end, they're unveiled. And you know, they look great. And you know, only a part of it comes from the surgery.

So in that part, it definitely raises the expectation level on our patients. The thing that it does that is good for us, is it does show that plastic surgery can be helpful, plastic surgery can be life altering. And plastic surgery can really change people, how they live their lives going forward.

COHEN: Let's get to an e-mail now from Sonica in Michigan who asks, "Is it wise to have two plastic surgeries done at the same time? Is it safe to be under general anesthesia for that long?"

Doctor, on these makeover shows, you sometimes see lots of multiple procedures being done. How safe is that? As Sonica points out, you can be under anesthesia for several hours.

KARP: Well, it's not the number of procedures that are done. We frequently do multiple procedures in one surgical setting. And I think that it's more efficient and probably safer for the patients to have one surgery with multiple procedures.

The issue really is the length of the operation. I think when you get to six, seven, eight hours of surgery, the risk of anesthesia, the risk of surgery goes up. So I think when a patient is considering multiple surgical procedures, they have to make sure they ask their surgeon how long is this procedure going to be before they go ahead.

COHEN: Another question now from Sharon in Pennsylvania. Do you need to lose weight before having a tummy tuck? And how difficult of a procedure is it? What is the recuperation time?" Lots of questions here.

First, doctor, what is the best weight as which to have a tummy tuck? Is there an ideal weight?

KARP: Well, we like the patient to be at a stable weight for them. We don't like them to be grossly overweight. We don't like them to be obese. I like them to be at a stable weight. If they can lose weight and get to a good weight that they can maintain over a period of time, then that's the best way to do the tummy tuck.

COHEN: So if you sent some patients back, have you said you know what, this just isn't working. Your weight needs to stabilize first?

KARP: Absolutely. And sometimes I'll suggest to the patient that they should lose 20, 30, 40 pounds before they really become a good candidate for a tummy tuck.

COHEN: Now doctor, you brought some pictures of a tummy tuck. Tell us, how long is the recuperation from this surgery?

KARP: Well, the recuperation, there's a short term and long-term part of the recuperation. The short term recuperation in terms of being back to normal activities is about one to two weeks. And then there's a longer term, which is what it takes to really get back to doing full exercise and lifting. And that may be more like four to six weeks.

COHEN: And the scar on that tummy tuck, we can see it. That goes from hip to hip?

KARP: Absolutely. It's a real scar, but you can also see the contour difference between, you know, the pre and the post op pictures.

COHEN: Well, grab a pen. When we come back, important information if you're considering plastic surgery. ANNOUNCER: From picking a surgeon, to before and after pictures, Web sites to check out are coming up. And...

UNIDENTIFIED FEMALE: It's almost as though I, you know, drink milk every day. Then all of a sudden it could become the milk diet if it's someone who's, you know, hot in the media.

ANNOUNCER: How far are you willing to go to get that star body, coming up on HOUSECALL.


COHEN: Welcome back to HOUSECALL. From herbal injections to colonics, our "bod squad" finds out what the stars do to stay sexy.


SANJAY GUPTA, DR., HOST (voice-over): Celebrities are usually the first to jump on the hottest weight loss craze. The latest on the bandwagon, colonics, which flush several liters of water into the intestines, then draw it out along with weight.

The We Care Spa in California says it treats droves of celebrity clients, who indulge in detoxification regimens, including daily colonics. Colonic critics say you may lose too much water in the process and set your body chemistry off balance.

How about a quick fix for fat called mesotherapy? A cocktail of herbs, vitamins and medication is injected into the middle layer of the skin where fat resides.

MARION SHAPIRO, DR., MESOTHERAPY: It's a non-invasive way of reducing their bodies without any obvious telltale signs.

GUPTA: But many doctors skeptical. There are no long-term studies suggesting mesotherapy is safe or effective. But with so little research to support them, why do these weight loss plans have such celebrity appeal?

BOONE TAUB-DIX, REGISTERED DIETITIAN: Celebrities are no different than the rest of us. And everybody basically wants a quick fix.

GUPTA: Most experts still agree, moderation, and not the latest celebrity craze is the better premise for your next diet.

Dr. Sanjay Gupta, CNN, Atlanta.


COHEN: For more information about the procedures that we've talked about today, go to, home of the American Society for Aesthetic Plastic Surgery. Or clickover to Both Web sites have tons of before and after pictures, plus detailed descriptions on what you can expect from each surgery. Now doctor, something that struck me is the cost of some of these procedures we've been talking to. According to the American Society of Plastic Surgeons, just the surgeon's cost for liposuction totals around $2,000. Breast implants average about $3,000. And you can get a tummy tuck for a whopping $4,600.

Now that doesn't even include the anesthesia, the operating room, or other expenses. In your opinion, Dr. Nolan, why is it worth all of that money?

KARP: Well, I think that the patients derive tremendous benefit from these procedures. And in many cases, these are life altering procedures for the patients. And it really allows them to move forward and move their life in a different and better direction.

COHEN: Well, we're out of time for today. Thank you, Dr. Nolan Karp for answering all of our questions. And make sure to tune in next week when our "Body Works" series continues. We'll look at some non-surgical options in the battle against aging. From lasers to botox, that's next weekend at 8:30 a.m. Eastern. And don't forget to send your questions to

Thanks for watching. I'm Elizabeth Cohen. Stay tuned for more news on CNN.


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