Good & Bad Cosmetic Procedures

© MSN Healthy Living // © MSN Health
Pictured Here: Before and after photos of a successful forehead- and face-lift procedure
Are you considering cosmetic surgery? Join the club.
But beware. You’ll probably start by sitting down with your doctor and viewing his own private art gallery of surgical work. But what you don’t see—and likely will never see—are the doctor’s mistakes and misses. American physicians perform more than 10 million cosmetic surgeries each year, and the best in the business will agree: Not every patient has a pretty “after” picture to show.
Click the “Next” arrow to view slides of both good and bad cosmetic surgery outcomes, plus learn how to select the perfect physician for your needs. And remember this: Aging gracefully with cosmetic surgery should involve some serious shopping around—with no beelines for the sale rack, please!
By Bethany Lye for MSN Health & Fitness
1 of 14 Images courtesy of Dr. Peter Fodor of Los Angeles
Left: A pair of natural lips
Right: The same lips, fattened with fillers to achieve a younger, sexier look
The term “fillers” (also called derma fillers or injectable fillers) refers to a wide variety of substances that doctors inject into the skin to smooth out facial wrinkles or volumize facial skin. One of the newest and most popular fillers on the market is Restylane, which is made of hyaluronic acid, a sugar molecule that occurs naturally in our skin. Doctors use Restylane to erase wrinkles, contour the face and add extra plump to patients’ lips.  
The results of injecting Restylane may last for up to one year, according to the American Society of Plastic Surgeons. Injecting fillers is a minimally invasive surgery (it requires local anesthesia, at most). Dermatologists can perform the procedure, and it involves little to no recovery time. Still, if someone doesn’t do the job right, “You’re going to be embarrassed for a few months,” says Dr. Alastair Carruthers, a Vancouver-based dermatologist and the current president of the American Society for Dermatologic Surgery.
2 of 14 Images courtesy of Dr. Alastair Carruthers of Vancouver
The results of an unsatisfactory lip augmentation
Fillers are not foolproof. Inject too much filler, and the treated area can appear bumpy and swollen; inject too little and the problem area remains unchanged.
“The area where I think I’m seeing most problems with filler is the lower eyelid,” Carruthers says. “Because filling it out is glorious, but if you put in a little too much, now you’ve got bags under the eyes.”
Because both fillers and Botox pass through a needle, they are often grouped together. This association is wrong, says Carruthers, who is often credited with co-discovering the cosmetic use for Botox. “Being an idiot, you can still do pretty well with Botox; it’s a drug, and it’s safe and relatively easy to use,” he explains. “On the other hand, fillers work by filling a space, so precise placement is much more crucial.”
To find a doctor trained and experienced in injecting fillers, Carruthers recommends a little high-tech sleuthing. “The Internet is a great place to start. Google the physician and then contact the Better Business Bureau. Just make sure you’re searching for the ugly stuff,” he says.
3 of 14 Images courtesy of Dr. Alastair Carruthers of Vancouver
Left: Aging naturally
Right: The results of a successful face-lift surgery
Right now, in the world of face-lifts, endoscopic procedures are all the rage.
In a traditional face-lift, the incision starts at the sideburns and drops down around each ear and continues to the base of the neck. In an endoscopic face-lift, surgeons make several small incisions (often less than an inch long) into which they insert a slender, wand-like tube with a fiber optic camera attached. With the help of this camera, doctors can lift and reposition facial tissue, working directly with the muscles and tissues that are sagging (as opposed to just pulling back surface skin). As a result, the endoscopic face-lift involves shorter recovery times and a more natural look compared to the traditional face-lift.
4 of 14 Images courtesy of Dr. Peter Fodor of Los Angeles
Left: A doctor erased this woman's sideburns during a face-lift procedure
Right: Dr. Fodor performed a second face-lift surgery and restored the missing sideburns
In general, a good face-lift will reduce the appearance of facial wrinkles and excess skin without the treated skin appearing tight. A successful surgery will also preserve a patient’s original hairline and sideburns, as well as the integrity of their facial muscles.
A “botched” face-lift may suggest visible scarring or the permanent disappearance of a patient’s sideburns. Other common complications include a wind-swept, unnatural look or the persistence of wrinkles and loose folds of facial flesh, according to Dr. Peter Fodor, a Los Angeles plastic surgeon and former president of the American Society for Aesthetic Plastic Surgery.
5 of 14 Images courtesy of Dr. Peter Fodor of Los Angeles
Left: A doctor face-lift with unsatisfactory results.
Right: Dr. Fodor performed a second face-lift, this time with satisfactory results
To ensure that you will be satisfied with your face-lift, do the following:
  • Ask a lot of questions (write them down beforehand).
  • At the doctor’s office, view as many before and after pictures of the procedure as you can.
  • Make sure that your doctor has experience and training in the very procedure that you’re interested in.
And, as always, check for board certification, Fodor says, because studying the diplomas on their wall and researching their credentials on the Internet will only get you so far: “Unfortunately, some of these physicians will state on the Internet that they are board certified when they are not.” To find out if your surgeon of choice is really board-certified, contact the American Society of Plastic Surgeons (888-475-2784) or the American Society for Aesthetic Plastic Surgery (800-364-2147).
6 of 14 Images courtesy of Dr. Peter Fodor of Los Angeles
Left: A patient with loose skin and excess fat deposits on the upper arm
Right: The results of a successful brachioplasty surgery
Both weight gain and aging will cause the skin to stretch. Cue brachioplasty surgery (also called arm-lift surgery), which involves cutting away sagging skin from a patient’s upper arms. Physicians regularly perform this procedure in conjunction with liposuction. Brachioplasty surgery removes any excess skin and liposuction surgery removes all excess fat. The final result? Bye-bye flabby old lady arms.
7 of 14 Images courtesy of the American Society for Aesthetic Plastic Surgery
Left: Facial skin mottled with dark brown age spots
Right: Satisfactory results from IPL therapy
Intense Pulsed Light (IPL) therapy involves exposing the skin to pulses of a broad spectrum of light. By treating skin this way—as opposed to using a laser which emits just one specific wavelength—physicians can target a variety of skin imperfections at the same time. The appearance of scars, red splotches, large brown freckles, spider veins, wrinkles and acne can all be minimized with IPL therapy.
The downside to this technology? IPL takes time; a typical treatment regimen involves several sessions scheduled at three- to four-week intervals. And while each session involves little to no recovery time, the treated skin may remain red for one to three days.
8 of 14 Images courtesy of Dr. Alastair Carruthers of Vancouver
Left: Facial skin prior to IPL therapy
Right: The same patch of skin, burned from IPL therapy
Used incorrectly, pulsed light can burn and blister the skin. In addition, unequal treatment times can lead to uneven results.
If you are considering IPL therapy, be sure to ask your physician who will be performing the actual treatment. Pulsed light machines should be used under the direct supervision of a physician, according to the American Society of Dermatologic Surgery. “This means that the physician is right there in the room, and the machine is in the hands of someone who is properly trained,” says Carruthers. Registered nurses and nurse practitioners are usually a safe bet, as long as they’ve had more than one weekend of training, says the dermatologist. “It can get really, really ugly with poorly trained people using these machines,” he says.
In the field of dermatology, certification is also important. To verify that your dermatologist is certified by the American Academy of Dermatology, call (888) 462-DERM. To verify that your dermatologist also belongs to the American Society for Dermatologic Surgery (which requires physicians to have a specialty in dermatologic surgery) call (847) 956-0900.
9 of 14 Images courtesy of Dr. Alastair Carruthers of Vancouver
Left: A patient with saggy eyelids
Right: The results of a successful blepharoplasty surgery
As people age, their eyelid muscles weaken and their eyelid skin stretches. In addition, fat tends to accumulate around the eyes, causing “bags” to form above and below. Blepharoplasty surgery, commonly known as “eyelid” surgery, is intended to remove excess fat, muscle and skin from the upper and lower eyelid, according to the American Society of Plastic Surgeons.
Certain health conditions like diabetes, high blood pressure and hypothyroidism may increase the risk of complications associated with blepharoplasty. Following the procedure, some patients find it difficult to close their eyes during sleep. On rare occasions, this condition is permanent. To minimize the chance of surgical complications, the ASPS advises patients to follow their doctor’s instructions closely before and after the operation.
10 of 14 Images courtesy of Dr. Peter Fodor of Los Angeles