Extreme Cosmetic Surgery Procedures

Have you ever showed your stylist a photo of a celebrity and asked for the same haircut? Or gotten the same purse as the one owned by your favorite actress? What about buying the same nose?

According to the American Society of Plastic Surgeons, more than 12 million cosmetic procedures were performed in 2008. And in the pursuit of supposed perfection, some people will stop at nothing — from breast augmentation to other implants to foot surgery — to create the ideal image they have for themselves.

The Price of Beauty

“First, we need to define extreme,” says Marc Klein, MD, a board certified plastic surgeon in Atlanta, when talking about certain cosmetic surgeries. “It can include lengthy procedures that involve three to five body areas at one time. The other kind of extreme cosmetic surgery includes those that, even though they get a lot of buzz and press, are done by very few surgeons and may be somewhat questionable.”

Dr. Klein says that patients with unrealistic expectations are part of the “too extreme” category. Extreme patients may be impossible to please, obsessive about tiny flaws, mentally unstable, or all of the above. This obsession with creating the “perfect” outward appearance is especially noticeable in patients with body dysmorphic disorder (BDD). People with BDD have a skewed, often false and very negative, view of how they look. They may go through many cosmetic surgeries, never feeling completely satisfied with the results. “There's a significant percentage of BDD with these patients,” says Klein. “They are much more critical of themselves.”

Uncommon Cosmetic Procedures

Cosmetic surgeons specialize in different areas of the body and different procedures, but for the most part, surgeries like rhinoplasty (nose job) and abdominoplasty (tummy tuck) are fairly common. Cosmetic surgery involving body part augmentation with implants, including pectoral, calf, biceps, and buttock, have yet to really catch on for a mainstream clientele. Other procedures, such as cosmetic foot surgery, may seem extreme, but are becoming more popular for women concerned about the appearance of their feet.

Here is a snapshot of some of the more unusual cosmetic procedures:

  1. Toe shortening. If a patient has a toe that's too long for her liking, surgery can correct the issue. The procedure usually takes about 15 minutes and involves removing a piece of bone. This type of foot surgery is an outpatient procedure and will temporarily make walking difficult. The risks, like infection and prolonged swelling, are the same as any regular surgery; extreme and fairly uncommon risks include the loss of a toe or long-term nerve damage. “Toe shortening has become quite popular over the years,” says Oliver Zong, DPM, a podiatrist and cosmetic foot surgeon in New York City. “Ten years ago, people weren't aware they could get the procedure.”
  2. Toenail removal. For the most part, toenail removal surgery usually is performed because of ingrown or chronically infected nails, such as those common among runners and other people who expose their feet to repetitive injury. Before going the surgical route, many podiatrists will first try medication, like terbinafine (Lamisil), to improve ugly fungal nails. If that doesn't work, a foot surgeon can remove all or portions of the nail in the hope that it will grow back healthier. (It takes three to six months for toenails to grow back.) Toenail removal is a simple foot surgery that takes about 5 minutes and can be performed in a podiatrist's office. Pain is a risk, and there is the possibility that the toenail won't grow back or won’t look perfect, says Dr. Zong, who explains that these aren't really new medical procedures, but that they are now being done for cosmetic purposes as well.
  3. Skin lightening. Making one's skin lighter just for the sake of it is very uncommon, says Klein. However, there are patients who have uneven pigmentation due to sun damage or even pregnancy (a condition called melasma). A dermatologist may treat the patchy look by using a combination cream of retinol and hydroquinone, a skin-lightening agent. Other treatments include laser surgery, chemical peels, and microdermabrasion. The main risk of these treatments is skin irritation and redness.
  4. Oversized breast implants. Breast augmentation is the most popular cosmetic surgery in the United States. The largest implant size that a surgeon can order from a manufacturer is 850 cc (an approximate increase of three cup sizes), and there is a small minority of women who want oversized breast implants, depending on the size of their bodies. There are size limitations with silicone-gel implants because they come prefilled; saline implants can be inserted through various incision sites and then filled to the desired volume upon proper placement. Besides the normal risks associated with regular breast implants, including changes in nipple sensation, ruptures, and pain, oversized implants also carry the risk of improper positioning, stretching of the skin, “bottoming out” (when implants sink), and extrusion (when implants erode through the skin).
  5. Biceps implants. Very few cosmetic surgeons will perform biceps implants, which use solid silicone, because of the associated problems. Risks include infection, nerve or muscle damage, and implant movement. “You just don't see biceps implant surgery — 95 percent of plastic surgeons don't want to do it,” says Klein. “It doesn't make sense in terms of the well-being of the patient.”
  6. Butt implants. This procedure uses solid silicone, the same type of implants used in pectoral, biceps, and calf surgeries, and is placed either goes above or below the gluteal muscle. Because the gluteal muscles are involved in many lower extremity movements, there is more post-operative pain associated with this type of surgery. There is also a high risk of infection.
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