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What’s Plastic About Plastic Surgery?
By Dr. Alan Engler

What’s Plastic About Plastic Surgery?
Actually, quite a bit. But do you know why plastic surgery is called “plastic”? While most people think that it’s because plastic materials (like silicone) are used in plastic surgery, the term was in use long before implants made of plastic were developed. Plastic actually refers to the strict definition of the word: “capable of being molded or of receiving form.” Used in the sense of changing the position of skin and moving skin and tissue from one part of the body to another, this meaning of plastic came to be used for the materials we now call plastics, not the other way around. Plastic surgery itself is plastic: new developments, technologies, and techniques emerge on a regular basis. This first issue of the newsletter article will document and discuss five of the most significant trends in plastic surgery.

1) More surgery through smaller incisions, which means less scarring.
Liposuction is the best example of this trend. Virtually unknown thirty years ago, liposuction is now the most commonly performed cosmetic surgery in the United States. Using incisions that typically measure half an inch or less, nearly every part of the body can be re-contoured. While the most common areas are the stomach, hips, and thighs for women, and the chest, stomach, and love handles for men (and the chin/neck for both!), it is also used on many other areas. Dramatic changes can be effected with only minimal “evidence” being left behind. Another example is the “transconjunctional lower lid blepharoplast,” which is the removal of fat bags under the eyes using small incisions placed inside the lower eyelid itself, leaving nothing visible on the skin. This procedure is often combined with laser resurfacing to tighten the skin. A third example is saline-filled breast implants. This implant is inserted empty and then filled once it’s in place. Compared with silicone implants, which come pre-filled, a similarly sized saline implant can be inserted through a smaller incision, thereby leaving a smaller scar.

2) Younger patients having smaller procedures, and dividing one big procedure into several smaller ones.
Instead of waiting until there would be the most dramatic changes, patients are undergoing procedures at an earlier age (i.e., a Maintenance philosophy). Aside from there being “less to do” on younger patients, the recovery tends to be easier. Less time is therefore lost from work and one’s regular routine. Similarly, instead of combining several procedures into one big session, patients are more likely to have a long-range plan for what they want to do, and have things done as they “arise”. Typically, this might be eyelid surgery in one’s thirties or forties and a facelift in one’s forties or early fifties, with liposuction of the chin, BOTOX and Collagen injections in between.

3) The diminished role of the doctor as teacher
It used to be that the doctor was the patient’s primary – if not only – source of medical information. While the doctor remains a key resource, the explosion of information available in books and magazine articles and particularly on the Internet has changed the way information is obtained. Patients routinely arrive at a consultation already knowing a lot about the procedure(s) they’re interested in. This is really to everyone’s advantage. Patients get a lot more out of a consultation when they already know the basics. That way, they can use the time they spend with the doctor to see how the generalities apply to them, to ask any specific questions they have, and, in another function of the Consultation, to better assess the doctor and his or her office staff. In brief, Sy Syms has it righ
Article Courtesy of Alan M. Engler, M.D., F.A.C.S., a New York City Breast Augmentation Surgeon

Additional Articles about Breast Implants by Alan M. Engler, M.D., F.A.C.S.:
How Anatomic Are Anatomic Breast Implants?
There are many choices that the prospective breast implant patient has to make. Aside from who will be the surgeon, the patient has to think about what size implant she wants, what style, location (above or below the muscle), and which incision. The following discussion explores one of the most basic decisions concerning the implant style: Round or Anatomic?
I view it as a privilege to do what I do -
Interview with Dr. Alan M. Engler from "Aesthetic Surgery - TASCHEN"
Implants Update
Expect further data down the road: manufacturers will be conducting a ten-year study that tracks 40,000 women who've received implants.
The Latest on Silicone Gel Breast Implants
You never know when the latest chapter in the saga can be called the Last Chapter, but there is a significant development recently that may shed even more light on – if not provide an epitaph to – the Silicone Gel Breast Implant Controversy that started in the early 1990’s.


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