|More and more people just aren't
willing to accept what God gave them.
Vanessa, by all accounts, is a
beautiful, vibrant young woman, yet when she looks in
the mirror, she feels she's lacking something. So, after
doing some research and finding out she could finance
more cleavage, the 28-year-old is preparing for a
consultation with a local plastic surgeon. For her, it's
about improving self-image.
"If I had those, I wouldn't have a
problem," she says, pointing to a buxom co-worker's
D-cup bust. Some cheer her on while others try to
discourage her, but Vanessa is determined to go through
with the surgery. "I am really a 32B/34A," says the
advertising associate, who wishes to remain anonymous.
Vanessa, who lives in Port Washington,
is about to join the more than 360,000 women nationwide
who had breast augmentation surgery last year, according
to the American Society for Aesthetic Plastic Surgery
(ASAPS). She isn't at all worried about volunteering to
go under the knife, and like many of the patients who
came before her, conducted her own investigation into
the increasingly controversial industry of medically
Inside the operating room of a local
plastic surgeon, another woman, a 38-year-old mother of
two, has a breast lift to rejuvenate her chest. The
effects of childbearing brought the mother, who also
wishes to remain anonymous, to the decision to have
implants. But the finished product of new soft curves
requires the sterile, bloody precision of the doctor
cutting open her flesh while she's under anesthesia. It
may not be open-heart surgery, and the procedure may be
practically routine, but the gore—like that seen on
Dr. 90210 or Nip/Tuck—is not for the faint
Patients can find it difficult to sift
through all of the information, while dermatologists,
ophthalmologists (eye doctors) and otolaryngologists
(ear, nose and throat doctors) compete with the
traditional plastic surgeon for clients bombarded with
endless innovations in cosmetic procedures. For
techniques such as injections, chemical peels and laser
treatments, many doctors now have spas in their offices,
and numerous spas now have physicians onsite. But new
technology is constantly being introduced. And reality
television shows aren't making anyone's job easier.
"The people that I see who watch these
programs like The Swan and Extreme
Makeover are led to believe that more can be done
than can actually be done," says Dr. Arthur Wise, a
veteran Roslyn Heights-based plastic surgeon. What
people don't realize, he says, is that
artists and cosmetic dentists "add greatly to the
results." But like most of Long Island's cosmetic
surgeons, he believes patients in the region who are
exploring the option of elective surgery are
Like Wise, Dr. Alan Kisner started his
career about three decades ago. Both have private
practices and also perform reconstructive and plastic
various hospitals. But unlike Wise,
Kisner has moved his practice away from doing solely
surgical procedures, and has also brought a spa into his
office in order to embrace the demand for less-invasive
"Some people focus on the immediate
return to socialization, but my patients are relatively
well-informed as far as expectations," says South Africa
native Kisner, who is also the chief of plastic surgery
at Huntington Hospital.
For better or worse, the ravenous
demand for beauty doctors is sucking up the supply of
healers as medical school students seek to ensure
themselves promising futures. Dr. Balvant Arora, an
assistant professor of plastic and reconstructive
surgery at Stony Brook University Medical Center, says
the number of students in the field has increased
"almost 20 to 30 percent."
Stephen Greenberg performs a
breast augmentation on a
woman at his Woodbury office.
Picking A Specialty
The varying focus of each surgeon is
just the epidermis of the issue.
"When I first came to Long Island, in
Nassau County there were four or five plastic surgeons,
and in Suffolk County there were another four," says
Wise. Those patients who were bold enough to challenge
the old-fashioned stigma of plastic surgery and were
rich enough to afford it back then often traveled to New
York City instead, he says.
Now consumers can choose from more than
80 surgeons on the Island who are board certified by the
American Board of Plastic Surgery, Inc. (ABPS). This
certification means that the doctor has graduated from
an accredited medical school, has completed at least
five years resident plastic surgeon training, and has
completed comprehensive written and oral exams. That
doesn't include doctors who claim to be plastic surgeons
who are board certified, but not by the same
organization. The only board that matters is ABPS,
experts say. "Doctors say they're board certified but
they don't say by what board, and the public in general
doesn't know the difference," says Dr. Elliot Duboys, a
Woodbury-based plastic surgeon.
Then there's a bevy of skincare
specialists, a growing number of MediSpas, or health
clubs that come equipped with nurses, doctors or
aestheticians. And then there are the head and neck
doctors (otolaryngologists) who perform cosmetic
operations on the face, and the skin doctors whose work
is mostly noninvasive (procedures that don't require
Choosing may not be easy, but it's not
impossible either. "The bottom line is: If the surgeon
is good at what they do and they have a good aesthetic,
can do a good job," says
Bosniak, a Great Neck-based eye surgeon with offices in
Manhattan—a specialty that is the minority in the turf
wars of cosmetic doctoring.
"[The] doctor has to know how to do
surgery, has to know how to use lasers, [and] has to
know how to give injections, so that when they offer the
patient a plan of treatment, the patient knows that
there's not a bias," Bosniak says. "That it's not a
doctor who only does surgery because the answer to
everything is going to be surgery; that's not the state
of the art anymore."
In the other corner are dermatologists,
also physicians, who do simpler aesthetic work such as
laser hair removal and Botox injections, and who tend to
use cutting-edge external procedures to improve the
patient's skin. These doctors have been in the business
of making skin look better, but in recent times they
have become more proactive about their approach rather
than simply treating skin ailments.
Bias isn't all a prospective patient
should worry about. "The turf battles are the most
confusing," says Dr. Leland Deane, of Garden City-based
Long Island Plastic Surgical Group. "The most important
thing is for the doctor to share their background with
the patient first," he says, noting that some
advertisements intentionally blur the lines by saying
doctors are "board certified" but don't say by what
organization. There are gynecologists (physicians
specializing in the care of women's reproductive
systems) and gastroenterologists (doctors who specialize
in the care of the stomach and intestines) performing
liposuction, the surgical removal of fat deposits from
under the skin, he says.
Vanity is big business, and for a
culture as obsessed with good looks as the LI culture,
business is booming.
"I even pray to God at night, 'God, can
you make my boobs grow?'" says Vanessa, before her
consultation with a local cosmetic surgeon.
Dr. Joseph Onorato injects
into a patient.
So Much To Choose From
Nationally, there were more than 11
million surgical and non-surgical cosmetic procedures
performed last year, according to ASAPS. One of the
reasons may be affordability. Formerly only available to
the affluent, cosmetic surgery has come down in price as
baby boomers start to hit the wrinkle years, and has
rapidly worked its way into the mainstream. Procedures
are simpler and cheaper, and with just about everyone in
Hollywood doing it, the stigma is gone.
"Cosmetic surgery patients used to hide
out until they healed; now they run to the diner to show
off the work they had done," says Dr. Stephen Greenberg,
a Woodbury and Manhattan-based ABPS-certified plastic
surgeon who regularly hosts plastic surgery seminars and
writes a column for the Press.
According to ASAPS, if you count new
treatments, like laser skin resurfacing along with the
old standbys such as face-lifts and tummy tucks,
Americans spent about $12.5 billion on surgical and
noninvasive cosmetic procedures last year. That's a 444
percent increase overall since the group started
tracking cosmetic procedure statistics in 1997—and the
equivalent of one in 20 Americans having "a little work
done." With increased affordability and accessibility
drawing in younger patients, the industry grows each
Among the noninvasive procedures, the
most well-known uses Botox, a type of toxin derived from
bacteria, Botulin toxin. Botox is injected through the
skin into a muscle to keep it from tightening and
temporarily suspend the appearance of wrinkles in the
face. The process sounds nasty, but some people will do
anything to prevent crow's feet and frown lines from
nesting between their brows.
Then there's Restylane, a close second
to Botox. Injection of this non-animal acid, made from
fermented bacteria, also involves little in the way of
recovery and discomfort, but instead of erasing the
wrinkles like Botox does, it fills in the wrinkle lines.
While the filler lasts about the same period of time as
Botox—about six months—this quick fix ranks among the
most common noninvasive cosmetic procedures because of
its ease and accessibility.
Local doctors, who do everything from
rhinoplasty (a nose job) to innovative treatments such
as the VelaSmooth laser (which nonsurgically treats
cellulite), often offer financing packages for the
"Plastic surgery on Long Island is at
least half the price of Park Avenue plastic surgery,"
says Wise. Although there are surgeons in other areas of
New York City who do similar work, "There's no reason to
go into the city," he says, adding that many doctors
have offices in the city in addition to a local
practice. "You have the same modalities here as you can
get anywhere else."
Major surgery still can cost several
thousand dollars, but minimally invasive
like micro-dermabrasion, a sort of sandblasting for the
face, can cost a mere $150. Botox and Restylane each
usually run upwards of $500, depending on the doctor and
the extent of the procedure. But when it comes to
shopping around, price should be second to
professionalism when choosing a doctor, experts say.
Surgery, lipo and Botox are not the
only measures Long Islanders are choosing. There are a
variety of nonsurgical and even holistic procedures that
fall under the loose title "preventative cosmetic care."
Also gaining in popularity is the ancient practice of
Chinese acupuncture. Like the East's green tea and yoga,
this, too, has been harnessed for beauty purposes.
"Acupuncture is used for facial
rejuvenation. It helps get rid of fine lines by
stimulating the muscles," says Ronald Sandoval, an
acupuncturist at the Huntington Holistic Health Center.
"It is suitable for any age. The younger you begin the
better. Prevention is the best medicine," he says.
There are a number of obscure surgeries
that don't get talked about everyday. Such procedures
include cheekbone chiseling or implants, tattoo removal,
butt augmentation and chin augmentation. Many are
one-day, outpatient procedures. Most of these procedures
are requested by both sexes, but there are
gender-specific procedures as well.
For men, there's calf, pectoral, and
penile implants, which can be used to treat erectile
dysfunction. Penile implants should not be confused with
penile enlargement surgery or phalloplasty. For women,
labiaplasty (labia reduction surgery) and hymen repair
are available for various reasons—cosmetic, hygienic, or
to relieve discomfort during sex.
The Changing Face Of Fountain Seekers
The increased acceptability of cosmetic
medicine has brought with it younger patients, both male
and female, in addition to the baby boomers who are
coming up on 60. A rising interest in pre-emptive
procedures, such as "mini lifts," which offset the
desire for full-fledged plastic surgery when patients
grow older, has fueled doctors catering to younger
Metrosexual or not, men are taking
better care of their physical appearance than in the
past. Some aesthetic (cosmetic) surgeons estimate that
men now make up as much as 25 percent of their
clientele—although the ASAPS puts the nationwide number
at 9 percent.
Liposuction, eyelid rejuvenation
surgery, Botox injections and laser hair removal are
among the most popular treatments men go for, according
to ASAPS, although they now can also get implants in the
chest to give the appearance of large pectoral muscles.
While acquiring fake muscles may be
extreme, most patients just want to look better. Some
men and women ask to be re-formed as someone famous,
with the most common current choices being Brad Pitt and
Angelina Jolie, according to a study conducted by the
American Academy of Facial Plastic and Reconstructive
Cosmetic surgery is also becoming more
acceptable among minority patients. Racial and ethnic
minorities accounted for 20 percent of all cosmetic
procedures in 2005, according to ASAPS. Hispanics again
led minority racial and ethnic groups in the number of
procedures at 9 percent, while African-Americans made up
6 percent of patients and Asians consisted of 4 percent.
Natalie Balboa, a 52-year-old Long
Beach housewife and cosmetic surgery patient, says, "A
lot of the young girls don't need to start when they do.
I have nothing against wanting to feel better about
yourself, but some of these girls want to be Barbie
Only 2 percent of all procedures were
performed on patients younger than 18 years old in the
U.S. last year, according to ASAPS. The most common
procedures for those 18 and under were laser hair
removal, microdermabrasion, rhinoplasty or otoplasty
(surgical alteration of the outer ear) so the child
isn't ridiculed. Local doctors say that while demand is
up in all age brackets, they won't perform major surgery
on minors without parental permission and without a
"Ideally, the parents should be in
complete agreement and support of the
Greenberg says. "At the same time, the teen should be
undergoing the procedure solely because the teenager
wants it and will benefit from it, not because of anyone
else's expectations." It must be kept in mind that the
child is still growing and changing, he says.
"I never thought I would get surgery
when I was young, but then you get older and things
change," Balboa laughs, motioning toward her torso.
"I think some of the young girls abuse
the idea of surgery. It becomes unreasonable," says
The Dark Side
But if plastic surgery has become so
common that people talk about so-called "lunch hour"
procedures, it is still surgery, and the risks are not
to be underestimated.
Debbie Mandel, a stress management
therapist, Brooklyn College lecturer and author of
Turn on Your Inner Light: Fitness for Body, Mind and
Soul, witnessed the dark side of plastic surgery
firsthand. The former high school teacher says one of
her students died on the operating table while
"His girlfriend broke up with him, told
him he was fat," Mandel, who taught English, says. She
still thinks about that student, even though it has been
nearly 10 years.
"During the liposuction procedure, his
heart stopped from the anesthesia. Since it wasn't done
at a hospital, but at one of those centers, they didn't
have the kind of equipment hospitals have to revive
someone in that condition," she says. In 2005, an
estimated 48 percent of procedures were performed at
private offices, 28 percent at freestanding surgical
centers and 24 percent at hospitals, according to ASAPS.
Over the past decade there have been improvements in the
in non-hospital settings,
"He would have been a brilliant
lawyer," laments Mandel.
Stony Brook's Dr. Arora advises
patients to find out about the surgeon they are
considering before going under the knife, and to be sure
she or he is certified with ABPS. Besides having the
burden of keeping the patient healthy, plastic surgeons
must also "visualize the desired outcome," says Arora.
"The most important component of this
surgery is to listen to the individuals and to know what
their expectations are," he says. Health risks also need
to be considered, Arora adds. "I think the most
important thing we look at is to minimize the risk that
is inherent in each procedure."
Filling The Void
The pervasiveness of the instant
transformation seems inescapable. Newspaper
advertisements show amazing before-and-after pictures
with the offer of "a better you," television portrays
the Zen-like happiness of post-op models, and even radio
touts financing options for every type of implant.
Although an argument can be made that
prevalence of marketing is to blame for the rise
in cosmetic surgery, therapist/author Mandel, who is an
advocate for natural solutions to body image concerns,
that there is an underlying problem of
insecurity and unhappiness that plagues both sexes.
"I would tell someone considering
plastic surgery to do some soul searching," she says.
"Ask yourself: 'Will this really make me happy?'"
Although optimistic about non-surgical
body improvement, Mandel is aware that addressing these
issues is an uphill battle, and anticipates that in a
youth-oriented society, the concerns need to be
addressed on an individual basis.
"Plastic surgery becomes addictive. A
woman has a face lift, then she notices her nose sticks
out, so she has a nose job, then she notices her
forehead sags, so she has Botox, then it's her lips,
then her underarms," Mandel cautions. "There comes a
point when she has to realize she is not addressing the
core issue; there is a problem there."
Body alteration addiction is nothing
new. About 7 to 12 percent of cosmetic
patients have body dysmorphic disorder (BDD), according
to the American Psychological Association. BDD is a part
of the obsessive-compulsive spectrum of disorders. An
estimated 2 percent of LI residents suffer from BDD, say
experts like Dr. Fugen Neziroglu, a Hofstra University
"If your appearance is causing
incredible distress and obsessionality," says Neziroglu,
"then I think that maybe it would be preferable to deal
with it more therapeutically than cosmetically.
"These patients will really never be
satisfied with whatever the plastic surgeon has done,"
adds Neziroglu, who is also clinical director of the
Great Neck-based Bio-Behavioral Institute, a private
medical, psychological and nutritional research and
"They go for repeated surgeries, they
tend to be perfectionists and they're looking to change.
"Patients who fall into this category
feel worse after the surgery, [they] may
dissatisfied with their appearance after surgery,"
Not everyone who has repeated cosmetic
procedures has this form of obsessive-compulsive
disorder. According to AAFPRS, about half of the people
who had a cosmetic procedure performed returned for
another within the same year. Researchers at ASPAS'
Educational Research Foundation released a study
recently that found that plastic surgery patients
experienced a decrease in the frequency of negative body
image emotions even a year after the procedure.
For some, however, cosmetic
improvements are simply a way of life. While marketing
herself at a cosmetic surgery convention recently,
Gianna Miceli of Great Neck, the owner of
www.KillforThisHair.com, a site that sells hair
extensions, says, "You become addicted. You become a
junkie." She adds, innocently enough, "It's all very
girlie and it makes me happy."
Most of us have spent more time than we
care to admit wishing we were
better in some way.
The wish for a new body and eternal youth is a dream
that is often ingrained in the human spirit, but until a
time machine is developed that can freeze the aging
process, plastic surgery will be the Rosetta stone for
those seeking eternal beauty. And while Long Island has
more than one fountain of youth, just remember: Nothing
lasts forever. There is no surgery for that just yet.