Our Q&A with Dr. Haowen Liu, M.D., a plastic surgeon in Taiwan, on the basic facts of cosmetic surgery.
Q. What are your criteria for accepting patient requests for cosmetic surgery?
A. One must keep in mind that not all plastic surgeries are positive or beneficial to the patients, no matter if the results are successful or not (objectively). Some patients, for example, don’t appreciate changing too much, while the others don’t appreciate changing too little. Before the operation, plastic surgeons have to figure out precisely what and how much the patient wants, and rule out those patients who have unrealistic expectations from surgery or treatment. Thorough communication is a very important step to a positive aesthetic surgery. Fortunately, during my career as a plastic surgeon the positive feedback I got from the aesthetic patients were as many as those from my reconstructive patients from before. It doesn’t mean that every surgery I performed was perfect; it rather means every surgery I performed was needed (by the patient).
Q. What are the most popular cosmetic procedures performed for young Asian American girls?
A. They came mainly for blepharoplasty (usually double eyelid surgery), hair removal, or skin problems, such as nevus excision or IPL+RF treatment (a kind of non-invasive treatment which utilizes combined energy of intensified pulsed light and radiofrequency.) As the countries they come from (U.S., Canada, New Zealand, Australia) are dominantly Caucasian, eyelid and nose surgeries are most commonly asked for and performed. Other common treatment/surgeries include augmentation mammoplasty, square face (mandibule osteotomy, or more acceptable treatment—botox injection for masseter muscle), liposuction (face or body contour sculpturing), acne scar, etc.
Q. What are the limitations for getting some of these surgeries?
A. Any operation will be refused or deferred for patients under 18 years old unless her parents give consent. This is under the prerequisite that the patient makes the decision by herself (and that she’s not under the influence or pressure of anyone, including her parents), and after a full discussion with her parents and doctor. Operations not aimed at treatment purpose (e.g. restoring function) are not suggested for younger girls even if her parents agree. Certain operations, e.g. rhinoplasty (nose job) and mammoplasty (breast reduction or enlargement) should be deferred until the nasal bone/thoracic cage/pectoralis muscles are completely developed, which differs by age for each individual.
Q. Can you describe the general cosmetic procedures?
Double eyelid surgery—is only performed on (and usually, by) Asian people because of their different anatomical structure from Caucasians. I usually remove some skin, fat and muscular tissue to improve the “puffy” look of most Asian women, and in addition to create a double fold. Local anesthesia and operation time takes about 30 to 60 minutes, marked swelling lasts 2 to 4 days, stitches come out in 5 to 7 days, and the total recovery time takes around 6 to 12 wks. The approximate cost for this surgery is NT$ 25000-40000.
Nose surgery (rhinoplasty) — Asians mostly get the “augmentation rhinoplasty” procedure which involves local anesthesia, concealed incision in nostril, and a silastic implant. Operation time takes 15 to 20 minutes and recovery takes 2 weeks. The implant rejection rate is less than 2 to 5 percent, where sometimes you may need to have a cartilage graft from auricle for nose tip sculpturing. The approximate cost this surgery is NT$35000 to 60000.
Q. What are the circumstances where you don’t approve of a patient’s wish to get surgery?
1. When the patient has unrealistic expectations about the result of the surgery.
2. When the patient has uncertainty about the operation site or the extent of change.
3. If the patient has insufficient recovery time (because of a short stay, tight flight schedule, etc.)
4. If the patient has diabetes, cardiovascular disease, or is psychologically immature or impaired.
5. If the patient is under 18 years old, they’ll need parent or guardian approval.
6. Some operations could only be performed on physiologically developed patients (mammoplasty, rhinoplasty, bone shaving surgery, chin/nasal implantation, etc.)
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