D.C. Enhances Its Beauty

Alice Furman, 75, is an ebullient international art dealer based in Virginia who is wintering in Florida. Furman and her husband Arthur, 76, had just returned from their four-mile morning walk in Palm Beach when she spoke by the phone with The Washington Diplomat.

The subject: cosmetic enhancement — not something everyone would be excited discussing. But Furman said she’d be delighted to talk about her cosmetic procedures and the “wonderful, compassionate” doctor who did them because she views such surgery as part of a positive lifestyle that includes exercise, careful eating, and an active business and social life.

“I had a facelift when I was 48,” she revealed. “I wasn’t happy with the way I looked and felt I could do better. Dr. Jorge Reisin was my doctor.”

Furman has since had other plastic surgery procedures done by Reisin, whose offices are located in Maryland, including the removal of a skin cancer.

Furman said she thinks people in the Washington area are more open about cosmetic procedures than they used to be, but still more reticent about it than city dwellers elsewhere, especially in hotspots such as Los Angeles, Miami and New York.

Dr. Reisin agrees: “Washington is a very cosmopolitan, multicultural city,” he said. “But people here are less likely to volunteer that they’ve had a cosmetic procedure than on the West Coast. There they’ll announce it and hold a party to show it off!”

Reisin is a cosmopolitan man himself. He holds a medical degree from the Buenos Aires University School of Medicine; was chief resident of the New York Hospital (Cornell Medical Center) and Memorial Hospital in New York; taught physicians at Georgetown, Howard and George Washington universities; and in his spare time treats children in the Dominican Republic who suffer from birth defects and other health problems. Fellow physicians here have repeatedly voted him one of Washingtonian magazine’s top doctors, including most recently in 2008.

Dr. Anne Marie Nickodem, a cosmetic surgeon with offices in Virginia and Maryland, is another Washingtonian top doctor. She confirmed that she’s seeing more ordinary citizens in her practice — and some are often quite open about their cosmetic work. But others come from Capitol Hill, the State Department, embassies and the media — and prefer to keep their procedures private. “Politicians generally won’t have a procedure done while they’re in office,” Nickodem noted, although there are exceptions, and television personalities tend to have them done in between jobs, she said.

Dr. Michael Olding, head of plastic surgery at George Washington University Medical Center, said he too sees politicians and diplomats who practice “don’t ask and don’t tell” policies when it comes to cosmetic enhancement — something also seen by Dr. Talal Munasifi, chief of plastic surgery at Virginia Hospital Center in Arlington who is on the faculty at Georgetown University School of Medicine.

“I’ve done senators, congressmen, news people and they don’t talk about it. In New York and Los Angeles they tell all,” Munasifi said. Even so, he added: “More people are coming for cosmetic surgery than ever before. It’s mainstream now.”

National figures reflect that trend. According to the American Society for Aesthetic Plastic Surgery (ASAPS), there was a steep increase in all cosmetic procedures done in the United States over the last decade. Liposuction procedures for instance more than doubled between 1997 and 2007. Liposuction was joined by breast enlargement, eyelid surgery, tummy tucks and breast reductions as the five most frequent procedures done in 2007. In all, nearly 11.7 million cosmetic surgical and non-surgical procedures were performed in the United States in 2007, according to ASAPS.

There are some local differences among these trends, notably that more facelifts are performed in the Washington area. Munasifi said his top procedures in 2008 were facelifts, tummy tucks, eyelids and laser skin surgeries. George Washington University’s Olding listed eyelids first, followed by facelifts, breast augmentation and tummy tucks, while Nickodem’s clients most often asked for liposuction, breast enlargements or reductions, eyelid procedures, and limited facelifts. Reisin most frequently performed liposuction procedures followed by rhinoplasty (nose surgery) breast augmentation, eyelids and facelifts.

But the real story is the quality behind these quantities. Lasers have vastly improved over the last five years so that laser skin procedures now pose very low risks and little downtime. “And they are suitable for all skin types now,” Munasifi pointed out, whereas previously it was difficult to get good results for darker skins or people of Asian descent.

Advances in liposuction have also broadened its appeal. New techniques now inject fluids that tighten blood vessels, Reisin explained, so that there’s very little blood loss and more fat can be safely taken out. And newer endoscopic procedures allow for smaller incisions. “They’re minimally invasive and very effective,” Reisin said.

In addition, cosmetic fillers and injectables such as Botox and fat grafts have seen a dramatic increase in effectiveness because practitioners now use very fine needles to inject micro amounts of needed fluids. And “a new on-cue pain-buster catheter has revolutionized pain management,” according to Nickodem, describing how a fine tube is threaded under an incision and drips local anesthetic onto a surgical wound over a period of three days. Reisin praised this automatic pump as particularly useful in breast enlargement and tummy tucks, cosmetic surgery’s more painful procedures.

In fact, “less is more” seems to be the new motto in cosmetic surgery, Oldham observed, noting the greater popularity of smaller procedures and incisions, less aggressive lasers, incremental changes, and faster recoveries.

Still, surgery is never without its dangers, no matter how small. “You have to be very respectful of surgery,” Reisin cautioned. Recognized risks include scarring, infection, problems with wound healing and blood clots. Longer or more invasive surgeries, smoking, and poor patient health increase these risks. “I have every patient cleared by a doctor,” Munasifi emphasized.

That’s why finding the right doctor — or doctors — is essential. We asked our expert surgeons for advice on finding a good cosmetic doctor, and they unanimously said the best first step is to get a referral from someone who’s already had a procedure done. The next step — or the first if you’re new in town or have silent friends — is to do research and find additional candidates. ASAPS has an online physician database searchable by zip code, or just call a local hospital to get the names of plastic surgeons with outpatient clinics who qualify for privileges there. (“No” is not a good sign.)

Do you always need a physician? Not necessarily, but our experts advised that cosmetic procedures always be at least supervised by a physician and performed by certified professionals. Some procedures involving injectables or less aggressive lasers can safely be performed by registered nurses, physician assistants, nurse practitioners and properly trained laser technicians.

Above all, always check candidate credentials. The best cosmetic surgeons will be board certified by the American Board of Plastic Surgery, which has the most rigorous requirements. Doctors who are members of ASAPS or the American Society of Plastic and Reconstructive Surgeons also boast strong credentials.

But remember that there are many medical boards in this country and some don’t have high standards or lack recognition by major medical groups, our experts warned. And the phrase “board certified” can be misleading. Always ask, “which board” and “board certified in what?”

Doctors interviewed reported seeing patients who arrived on their doorsteps with botched cosmetic procedures, in part because any licensed physician can perform them. A gynecologist for instance who does liposuction may or may not have extensive training in it.

In addition to checking professional backgrounds, take a personal approach and be proactive in interviewing candidates, possibly bringing along a friend or family member for perspective. Ask about how many times the practitioner has performed a procedure and how frequently complications have turned up. If it’s a common procedure, a doctor should be doing it often, perhaps every week. Practitioners who are new to a procedure (fewer than 30 patients) should tell you that. Also ask to speak to patients, and look at before-and-after pictures.

“If anyone is offended by your questions, get up and walk out,” Nickodem said. Also walk away if you’re being pushed toward procedures you didn’t ask for, or simply if you don’t feel comfortable with a physician for any reason — it’s ultimately your decision and your looks that will be affected.

Patient-doctor relationships in the world of cosmetic procedures seem to be more personal and longer lasting than elsewhere in medicine. “I’m a very social person and many cosmetic procedures allow for social interchange,” Olding said. “I like to get to know my patients.”

Munasifi added: “I’m proud of my relationships with my patients. I know them and care about them.” Similarly, Nickodem said, “I do all my procedures. I’m hands-on and I get to know my patients. I’m available. They can call me.”

Reisin is clearly a “people person” as well. His proudest career moment, he recalled, was being voted “Teacher of the Year” at Georgetown’s medical school. Today, his surgeon son has joined his practice. “He’s board certified and we work as a team,” the senior Reisin said.

As for Alice Furman, if she needed a plastic surgery procedure, she wouldn’t have it done in glitzy Palm Beach. “I’d fly back home and have Dr. Reisin do it. I’m happy with him.”

SIDEBAR

What D.C. Gets Done

Here are some commonly used terms used in the world of cosmetic enhancement. (By the way, cosmetic or aesthetic procedures represent one of two types of plastic surgery, with the other being reconstruction.)

Breast procedures: A lift or mastopexy raises and firms breasts by removing skin and tightening tissue. Augmentation mammaplasty enlarges breasts by inserting silicone gel or saline-filled implants, while a reduction removes fat, tissue and skin to reduce breast size. Breast reconstruction rebuilds after a mastectomy and uses implants or body tissue.

Brow lift: A forehead lift deals with creases, sagging and frown lines by altering muscles and skin through incisions along the hairline. It may use an endoscope, a small tube with a light (and perhaps a tiny camera) that can be inserted into the body for surgical or examination procedures.

Chemical peels: These peels coat the skin with a chemical to remove the top layer and diminish fine lines and discoloration. Light peels have little or no down time. Deep chemical or phenol peels can involve one or two weeks of healing.

Eyelid procedures: A blepharoplasty surgically alters upper or lower eyelids.

Facelift: A rhytidectomy tightens sagging facial skin and muscle, removes fat, and restores firmness. It does not include brow, eyelid or nose changes.

Fat grafting: Fat injection procedures surgically remove fat from one part of a patient’s body and inject it into another part to reshape it.

Liposuction: A fat-removing procedure, liposuction contours the body by making an incision and removing fat through a hollow tube. Laser liposuction heats the fat first. Ultrasound lipoplasty liquefies it.

Injectables: Botox — the brand name for botulinum toxin — brow injections relax muscles that cause frown lines and last about four months. Dermal filler injections place a variety of materials under the skin to smooth wrinkles and create volume. Materials include gel or microsphere mixtures containing collagen or hyaluronic acid. Results can be permanent or last a few months.

Laser procedures: Laser skin treatments deliver beams of concentrated light to rejuvenate the skin. They can help with spider veins, wrinkles, scars, spots, tattoos and discoloration. Ablative lasers, such as carbon dioxide and “erbium:YAG” lasers, remove surface skin. Fractional ablative lasers such as the Fraxel laser deliver separated pinpoints of light. Less aggressive procedures can be done with non-ablative lasers that go below the skin surface but don’t affect the surface, or with non-laser pulsed light instruments that perform photo rejuvenation.

Tummy Tuck: Abdominoplasty is a surgical procedure that contours the abdomen by removing fat and skin and sometimes adjusting muscle.

Resources: American Society for Aesthetic Plastic Surgery www.surgery.org

American Board of Plastic Surgery www.abplsurg.org

American Society of Plastic Surgeons www.plasticsurgery.org

American Academy of Facial Plastic and Reconstructive Surgery www.aafprs.org

About the Author

Carolyn Cosmos is a contributing writer for The Washington Diplomat.