Plastic surgery conjures up all sorts of images, some positive and some negative. But the fact is that more and more people - both women and men - are discovering that they can look more attractive and feel better about themselves in spite of the aging process. At its foundation, aesthetic (cosmetic) plastic surgery incorporates artistic integrity with the finest technological advancements in surgical procedures and medical science. Ideally, the aesthetic plastic surgeon is able to deeply touch the lives of each patient, helping them actualize their true beauty.

While most medical specialties address the physical body, cosmetic surgery is unique in the way it brings together elements of the physical and the psychological. It is, after all, the ultimate elective surgery, because a patient clearly chooses it voluntarily. And the patient's motivation -- to look and feel better -- is directly connected to his or her sense of self-worth. Physicians and patients both need to consider motivation, expectations and other psychological influences before making a cosmetic surgery commitment.

The Face

There is nothing more obvious in the process of aging than the changes that occur around the face. They start slowly, insidiously and then, poof, one day you wake up and look in the mirror, and the person looking back at you is "old"! You don't feel old. In fact, you've never felt better! But what you see in the mirror is irrefutable. And for the first time, you begin to think the word "facelift". Some people swear they would never be so "vain" as to consider cosmetic surgery. Others know that if the time comes, they would not hesitate to make an appointment to see a plastic surgeon. They just didn't expect that "time" to come so soon!

Over 100,000 American women and men had facelifts in 1998 and significantly more than this had the surgery in 1999. Worldwide, the number is staggering! Of course, the aging process is not limited to the face alone. But while the aging of the rest of the body is happening, it's the facial aging process that's most apparent.While the term "facelift" to a plastic surgeon means a particular, highly specific surgical procedure, to the public in general, it may mean a variety of operations including an eyelid lift, a brow - or forehead lift, mid-facelift, lasering or chemical peeling around the mouth, and so on. In fact, the term "facelift" refers exclusively to the operation that tightens the face and neck areas only. In the process of surgical rejuvenation, the facelift is one of the most important surgical procedures.

As the aging process affects the face, several things are occurring simultaneously. The skin stretches and loosens, which results in folds of loose skin. At the same time, fatty deposits and normal facial fat contours that give the face its natural areas of fullness and shape are lost. Even bony contours are altered and muscles become slack. In some areas, especially around the lips, mouth, and eyes, deep chiseled and grooved lines result from the breakdown of collagen elastic fibers in the skin.In the facelift, loose areas are tightened. Excess skin is removed. The muscles and fatty contours that remain are returned to as close to their normal, youthful position as possible. However, the deeply grooved, chiseled lines are best treated by other procedures such as lasering, chemical peeling, and filling techniques. Lost facial fatty contours are best treated with filling agents such as fat (transplanted from other areas of the body), collagen, fascia, and other natural and artificial filling materials.

The Body

Currently the most commonly done aesthetic surgery, liposuction is a procedure producing almost instant gratification. By carefully removing and shaping excess fatty deposits from almost any area of the body, a new and permanent contour is obtained. While it is not an altemative to proper diet and exercise, it is a way to achieve incredible results immediately.

It is also, however, open to potential abuse as a weight loss alternative. These abuses may take the form of massive liposuctions in unsuitable candidates; poor patient selection in general; advertising-generated and misleading expectations; and non-plastic surgeons performing cosmetic surgery. Some of these abuses have resulted in spectacular complications and have generated lurid exposés in the media. This adverse publicity unfortunately places blame on the operation as opposed to the operators. This is regrettable, since liposuction is such a valuable cosmetic operation.

Anyone considering liposuction surgery needs to seriously examine both motives and expectations. What do you really hope to gain through liposuction surgery? Can it actually be accomplished by a combination of moderate weight loss and toning through exercise? Should you invest in a meeting with a nutritionist and a trainer instead of a plastic surgeon? Are your expectations for what surgery can do realistic? If your answers to these questions still lead you to want liposuction, you should prepare for your consultation carefully, armed with further questions.

Whether because of pregnancy, weight loss or just the natural aging process, the abdominal wall tends to relax. Weight-loss and exercise are rarely able to reverse the situation. In abdominoplasty or "tummy tuck", the muscles of the abdominal wall are tightened and rebuilt, defects repaired and the skin tightened to the point of smoothness.

The Breast

In the world of modern plastic surgery, a woman who is dissatisfied with the size, shape, position, or appearance of her breasts need not accept the situation as it is. There may be a surgical procedure to give her the bustline she desires. As with all cosmetic plastic surgeries, the best candidates are people in good physical and mental health, with reasonable and realistic expectations, who are looking for improvement, not "perfection".

For women who feel that the breasts are too small or have become too small after childbearing, augmentation may be the right operation. Through the insertion of an implant placed behind the natural breast tissue, either under or on top of the pectoral (chest) muscle, the breasts are filled-out, lifted and enlarged in a natural-appearing and pleasing fashion.

When there is too much skin laxity and sagging, a breast enlargement alone is usually not sufficient to produce the desired result of lifting, filling-out, and shaping. The causes include childbirth, weight loss, or just the process of aging. Under these circumstances, a mastopexy may be necessary. In this procedure, excess skin is removed, the breast tissue compacted, and the entire breast elevated to a more youthful location. Frequently, this process is combined with the insertion of an implant. When the problem is overly large, pendulous breasts, often causing back, neck, and shoulder pain, a reduction (mammaplasty) is the treatment of choice. The enlarged breasts and frequently over-sized areolae, can be sculpted and lifted to be both more comfortable and visually pleasing. There are several techniques for reduction. Sometimes, especially in younger women with large breasts and early signs of sagging, liposuction may provide a method for breast reduction.