Talk:Cosmetic surgery

This article is in progress. I'm putting some references in the outline of the article that I plan to come back to very shortly. The overall idea is to not only present an accurate narrative introduction to this field of surgery, but to do so while presenting the idea that "beauty is in the eye of the beholder"- with references!. Nancy Sculerati MD 14:57, 21 February 2007 (CST)

Should be at cosmetic surgery, right? It's not usually capitalized, is it? --Larry Sanger 08:47, 22 February 2007 (CST)

I don't know how to answer that. The field of Cosmetic Surgery is capitalized, but if a person was to undergo cosmetic surgery procedure it is not capitalised. That is true of Plastic Surgery, the field, the residency program-and Surgery, the field (discipline) as well. The field of Medicine, Surgery etc are always capitalized. If I am looking up one of those topics on a search engine, I always capitalize it.Nancy Sculerati MD 09:00, 22 February 2007 (CST)

I think you've answered it, but the issue would then be if one is describing surgery that is done to achieve a cosmetic effect, or whether one is giving an overview of the speciality named (Reconstructive and) Cosmetic Surgery. Since you in the first sentence define the article as being about the field, I'd be comfortable with the capitals. We are going to have the same problem with all the speciality fields of medicine, so at some time one would have to decide about a policy. On the other hand, if it makes no difference to a search for a subject, then it is probably of minor importance - the CZ engine does not seem to mind much, it picks up this article as a first hit for "cosmetic surgery". There is a Plastic Surgeon on board who might wish to wade in: User:Andy Wongworawat. That picture of Jackie looks like a Victorian ghost photograph on my screen, but the comment is right on. I like the outline/sections at this stage. --Christo Muller (Talk) 09:26, 22 February 2007 (CST)

Let us suppose that we are using the Chicago Manual of Style. My copy is packed away in a box... Anyway, the question here is whether names of disciplines are properly capitalized, in general. CMS might shed some light anyway. Often one does see Philosophy, particularly when one is speaking of the field as something formally studied (so, we usually say "Ph.D. Philosophy" rather than "Ph.D. philosophy"). But of speaking of the body of problems and literature about them, and about particular philosophies, we use "philosophy."

If this is correct, then the question is whether, when giving a title to a topic that can be either capitalized (when naming a discipline) or not (when naming what the discipline studies), which should we give it? Well, we may take the Biology article as an excellent example. I think we can agree that its first focus is on what Biology studies, but it nevertheless is organized around what the article calls a "formal science." (By the way, Biology is not a formal science; formal sciences include logic, mathematics, and parts of statistics and computer science. The better phrase in that case would be "scientific discipline.") So, as long as we make it a general habit of focusing articles on these topics at least nominally on the discipline, rather than on what the discipline studies, then we could use the upper case. --Larry Sanger 09:40, 22 February 2007 (CST)

I went shopping at Wikipedia Commons to find pictures, and I liked that portrait because the artist emphasized the square angle of her jaw. But maybe the quality is too poor to use? Nancy Sculerati MD 09:39, 22 February 2007 (CST)

I intuitively prefer a title to be uppercase. To take your philosophy example, if we had an article about "Athenian philosophy", it reads differently to me from "Athenian Philosophy", the former seeming to indicate thinking in the Athenian way, the latter indicating a School of Thought, so to speak (what about Citizendium pilot vs Citizendium Pilot?). As you say, if the focus is on the discipline as an entity, and the discipline is defined reasonably early on in the article, then the uppercase would be appropriate.

I'm sure we'll find clearer pictures, Nancy, but suggest you leave her as is, so that others can see what you wish to illustrate. It is a good example --Christo Muller (Talk) 13:54, 22 February 2007 (CST)

OK now I must ask, Nancy: why Cosmetic Surgery but plastic surgery? --Larry Sanger 11:49, 26 February 2007 (CST)

Top-down sequence of sections?

I was thinking about the rather random way in which articles about cosmetic surgery are structured. Generally they seem to go from major to minor, or common to uncommon. But we have a body to work with, so one can sequence things in the way one sees the body. For the sections describing the specific areas, my suggestion for a general top-down article structure would be:

• Facial Cosmetic Surgery
  • Whole face; hair transplant; forehead; eyes; nose; ears; cheeks; lips; chin; jaw; neck
  • (For each?) Tissue resection; implants; injections
• Facial Rejuvenation
  • Injections: Botulinum toxin; fillers
  • Resurfacing: Dermabrasion; Chemical Peels; Laser
  • Thermage (a trademark?)
• Body Contouring
  • Arms: lift
  • Breasts: Reduction; Lift; Implants; Gynecomastia
  • Abdomen: Abdominoplasty; suction
  • Hips and thighs: Liposuction; Implants; Lift
  • Calves: Lift
• Sclerotherapy - could fit in anywhere one wants veins reduced, bottom of legs common.

The sections clearly have some overlap, specifically as far as the face work is concerned, but this would give something to hang the content on. --Christo Muller (Talk) 14:09, 22 February 2007 (CST)

I'm happy with that- there will be a Reconstructive Surgery article as well, working on them in parallel. Nancy Sculerati MD 14:32, 22 February 2007 (CST)

Tone

I took the liberty of cleaning up the first section. The section was a long diatribe against our society's current tendency to proceed willy-nilly with cosmetic surgery. While I agree that cosmetic surgery has become a disgusting free-for-all, I'm not sure a diatribe against that belongs in a scholarly reference material. I'm not sure that CZ has as strict a policy about NPOV as wikipedia, but maybe a lot of the ethical background is better reserved for a medical ethics article. I thought a lot of the key points of the diatribe could be summarized in a set of bullet points, or someone can make a table. A long narrative about the complexities of patient selection for cosmetic surgery is probably better off in an editorial, unless it can be referenced by the literature. For example, maybe a section on the psychology of cosmetic surgery would be an interesting feature of the article. Just my $.02.--Michael Benjamin 14:36, 25 February 2007 (CST)

Citations

I think we should use the tools granted by MediaWiki for citations. There is a website that allows you to input a PMID and get back a "Wikified" citation template. For example, PMID 12447085 turns into "Isenberg J (2002). "The legacy of Narcissus". Plast Reconstr Surg 110 (7): 1815; author reply 1815-6. PMID 12447085. ", then you put \<ref\> \</ref\> (take the backslashes out) markups around that, and finally you put at the end of your page to print the references. The page for the template generation is: http://diberri.dyndns.org/wikipedia/templates/?type=pmid. This way we can establish a uniform system for citing references.

I think this article will be adequate when it has about 200 references. So far, we have 8. It's such a broad topic that you could spend a week just writing about saline breast implants, for example.--Michael Benjamin 22:16, 26 February 2007 (CST)

Lips

I think there's a lot of subjective stuff here, most of which is not that scientifically valuable. I deleted some, but if we want the rest to remain here, it should really be cited. As it stands now, a bunch of the info is unsubstantiated opinion. While a discussion of the differences between Grace Kelly's and Angelina Jolie's lips, for example, may be suitable for the pages of People magazine, readers of an encyclopedia may not benefit much from that knowledge.--Michael Benjamin 19:23, 25 February 2007 (CST)

This article is entitled Cosmetic Surgery and I disagree that a discussion of aesthetics and patient selection is "unscientific". The reason Angelina Jolie and grace Kelly are used is because there are pictures available, and because it is possible to refer to both women in a respectful manner while making an important point. The whole point of cosmetic surgery is subjective. The sections on patient selection and scope of surgery are very important, and are the topics that are stressed in the training of cosmetic surgeons, as well as focused on in the literature. I am sorry that they have been removed, and the tone taken about their removal offends me because of its arrogance. I don't know who wrote the above statement denigrating the value of what I have written, but the points being made in the comment show a lack of experience and training in cosmetic surgery. For example, the discussion of the aesthetics of the ideal feminine lips, and how those ideals are culturally biased, are standard in the field. Further, the most important aspects of cosmetic surgery. as important as actual techniques, lay in choosing patients who will benefit, and tailoring the appropriate operation for each. I do not know why these topics have been deleted and find it very frustrating to find the article changed in this manner. I have only done a few dozen cosmetic procedures myself, but have had close interactions in two of the most respected Plastic Surgery programs in the United States over a period of many years, and spent hundreds of hours in the operating rooms and in the surgeon's lounges discussing these issues, I have read the literature -much of which was written by the colleagues with whom I have had these discussions with, and, again, I do not understand why this article has been gutted. If you look at my plan for the article, it was to present cosmetic surgery in a form that was understandable to lay people and interesting to professionals. I find collaboration stimulating, but not "correction" of the beginnings of a legitimate article in this fashion. Nancy Sculerati MD 18:51, 25 February 2007 (CST)

No disrespect intended, certainly, but a lot of what you included in the original draft of the article was based on unsubstantiated opinions. I thought the whole point of Citizendium was to get away from the anticredentialism of wikipedia--the net result is that wikipedia is an amateurish document full of unsubstantiated opinions. The value of the scientific literature is that it is referenced--one may see where a particular idea comes from and read more about it from the source material. I think that's a valuable concept for an encyclopedia, and it's one that was not present in the article. You can see that I added placeholders for the statements you made on the page that could use citations. The fact that I happen to agree with a lot of your opinions did not make those opinions relevant for inclusion in the article, in my opinion. --Michael Benjamin 19:43, 25 February 2007 (CST)

You asked me to edit this article, and I took that to mean that you wanted serious critical review. As it says below, "If you don't want your writing to be edited mercilessly and redistributed at will, then don't submit it here." --Michael Benjamin 19:43, 25 February 2007 (CST)

I also thought that an important principle here is "neutral point of view." To me, this means that the author should take a tone of not coming down on one side of an issue or another, only presenting facts as reported in scientific literature. Again, I find that this article had a lot of problems with maintaining a neutral tone.--Michael Benjamin 19:43, 25 February 2007 (CST)

I think finding citations in the literature for your thoughts would make the article much stronger, and would make it less like original work (with certainly a lot of merit as such), and more like the reference piece it purports to be. Perhaps the piece should focus on more fact-based information, such as different techniques of cosmetic surgery and the history of the field, and less on long discussions of the psychology of cosmetic surgery and patient selection. Resources for patients are valuable, but so is providing information based on objective facts.

I do not represent myself to be an expert in cosmetic surgery--if you look at my talk page you will see that I am board certified as an internist, hematologist, and oncologist. My board certification and experience only count for so much, though. Even a credentialed expert, even one who has had long discussions in doctors lounges, and even one who has performed many of the procedures they are writing about can produce unsubstantiated opinion; the trick is to find justification for one's opinions in the literature!--Michael Benjamin 19:43, 25 February 2007 (CST)

If you disagree with my edits, it's relatively easy to revert them to the original using the history button. Your words are not lost forever when I edited the article. I do not intend to get into a "revert war" with you; if you can't live with my criticism, I will back off and leave your pages alone. I think I have made some valid arguments about why I did what I did, but if you don't agree that my reasoning here makes the Citizendium project stronger, feel free to edit your articles in any way you see fit. --Michael Benjamin 19:43, 25 February 2007 (CST)

A new start

I'd hate to revert because some of the things you've added, Michael, are important and I didn't think of them- if I revert, I might forget to put them back and so I will replace what I feel must be replaced. The topic of patient selection is not besides the point in Cosmetic Surgery but a major point that requires emphasis. Also, and I write this with a smile, the article should very much be of interest to the readers of People Magazine- as well as to Cosmetic surgeons. Some of your corrections are just plain errors- reconstructive surgery is not "function" whereas cosmetic is "appearance", for example. A woman who has a partial mastectomy on one side for a tumor and a breast reduction on the other side to correct the assymetry has not had cosmetic surgery at all-but reconstructive surgery. A woman who had the identical appearance of the breasts who did not have a tumor but who underwent a bilateral mammoplasty might end up with nearly the same result- done strictly for "beauty", and that's pure cosmetic surgery.

1. The aspects of cosmetic surgery that are important to plastic surgeons and those that are important to patients, and to interested readers all should be covered.
2. The scope of this article is not likely to allow discussions of saline v other kind of implants, for example- but an article on Breast Implants could include that in detail

We've developed a way of collaboration on Citizendium that has been pretty workable- if somebody has made a reasonable start on an article, but another author or editor (and those are pretty much synonyms except to when it comes to approval) thinks there are errors or problems in style about what has been written- that gets discussed on the talk age, before or along with, changes. Additions to the text are always welcome, but even more welcome with some discussion. So please return and continue, and we can learn better how to work together. Nancy Sculerati MD 09:58, 26 February 2007 (CST)

Looks like a pretty extensive revert on the matter of risks and benefits of surgery, irregardless of what you wrote above. You still haven't responded to my description of much of the first two sections as being unsubstantiated opinion--I still think they are. You no doubt have earned the right to your opinion, but that alone does not a scholarly article make. You see that my article on anemia, for example, follows a standard scientific article technique, where I make a statement, then provide a citation. I think many of the first chapters found in the plastic and (pardon me) reconstructive surgery textbooks must follow this tradition that we, as lovers of the scientific method, should also strive to adhere to. If we cannot, we are no better than our lowly colleagues at Wikipedia, with their crackpot theories deriving from only the ether.--Michael Benjamin 22:28, 26 February 2007 (CST)

I still contend that a more conventional discussion of the risks of cosmetic surgery should be presented. Your narrative is needlessly vague, and I think details such as risks of surgery in general and risks specific to particular procedures is pertinent. I think you should revert my edit to include my bullet points as a good starting point. There are probably many different cosmetic surgeons out there who could come up with other risks to put in there. It would be nice, for example, if "pulmonary embolus" or "infection" appeared in the narrative.--Michael Benjamin 22:28, 26 February 2007 (CST)

You know what I realize? We are probably wasting too much time arguing over small things when there really is an ocean of information left to be redacted. This all started where you asked me to edit your article. If you don't think much of my comments, fine. I'll be in the hematology section, adding references to "anemia." I think it'll be done when it has more references than the UpToDate anemia article.--Michael Benjamin 22:28, 26 February 2007 (CST)

reply to Larry

That's easy. I wrote the article title "Cosmetic Surgery" when starting the article, but Plastic surgery was an article or stub that got to Citizendium via Wikipedia at the start. ;-) Nancy Nancy Sculerati MD 12:10, 26 February 2007 (CST)

Well, we should make it all one way or the other, no? Or at some level of generality does the name of a medical process stop being the name of a discipline as well? --Larry Sanger 12:14, 26 February 2007 (CST)

I think it should be Plastic Surgery. Can you change it? Nancy Sculerati MD 12:53, 26 February 2007 (CST)

References

In Citizendium, we have been using footnoted references for quotes but not for statements that are generally accepted in the field. None the less, having a list of references is useful and important. In Snake venom, we kept a running list. It would be great if we could have a reference tab. Anyway- I'm starting a running list here of references read. Please add to it as needed.Nancy Sculerati MD 15:45, 26 February 2007 (CST)

Informed Consent

Makdessian AS. Ellis DA. Irish JC. Informed consent in facial plastic surgery: effectiveness of a simple educational intervention.[see comment]. [Clinical Trial. Journal Article. Randomized Controlled Trial] Archives of Facial Plastic Surgery. 6(1):26-30, 2004 Jan-Feb. UI: 14732641

Patient Selection

Edelstein J. Of chickens and red flags. [Editorial] Plastic & Reconstructive Surgery. 112(2):684-5, 2003 Aug. UI: 12900634 (editorial in which a plastic surgeon discusses ethics, funny)

Sarwer, David B. Ph.D. 1; Crerand, Canice E. M.A. 2; Didie, Elizabeth R. M.A. 2 Body Dysmorphic Disorder in Cosmetic Surgery Patients. Facial Plastic Surgery. Multi-Specialty Facial Plastic Surgery. 19(1):7-17, 2003.

Rohrich RJ. Mirror, mirror on the wall: when the postoperative reflection does not meet patients' expectations. [Journal Article] Plastic & Reconstructive Surgery. 108(2):507-9, 2001 Aug. UI: 11496196

Sarwer DB. The "obsessive" cosmetic surgery patient: a consideration of body image dissatisfaction and body dysmorphic disorder. [Review] [31 refs] [Case Reports. Journal Article. Review] Plastic Surgical Nursing. 17(4):193-7, 209; quiz 198-9, 1997. UI: 9460445 (includes algorhythm for deciding surgery -yes? surgery no. )

Muhlbauer W. Holm C. Wood DL. The thersites complex in plastic surgical patients. [Case Reports. Journal Article] Plastic & Reconstructive Surgery. 107(2):319-26, 2001 Feb. UI: 11214044 (a surgeon's view of body dysmorphism- some case histories "aesthetic surgery addicts")

Wright MR. Surgical addiction. A complication of modern surgery?. [Journal Article] Archives of Otolaryngology -- Head & Neck Surgery. 112(8):870-2, 1986 Aug. UI: 3718694 (more general view of surgical addiction-to elective procedures)

Miller M. Cabeza-Stradi S. Addiction to surgery: a nursing dilemma. [Case Reports. Journal Article] Critical Care Nurse. 14(3):44-7, 1994 Jun. UI: 8194349

Perugi, G., Akiskal, H. S., Gianotti, D., et al. Gender-related differences in body dysmorphic disorder (dysmorphophobia). J. Nerv. Ment. Dis. 185: 578, 1997.

Anonymous. Aesthetic plastic surgery for teenagers: when is it appropriate?. [Journal Article] Plastic Surgical Nursing. 17(2):91-2, 1997. UI: 9275789 (Reviews guidelines from national organizations)

Hutchison RL. Patient selection caveats. [Letter] Plastic & Reconstructive Surgery. 98(3):575, 1996 Sep. UI: 8701008 (letter: discuses the cosmetic surgery patient who tries to hide underlying serious illness, along with humurous advice)

Ritvo, Eva C. M.D. 1,2; Melnick, Ilan M.D. 1,2; Marcus, Gina R. D.M.D. 3; Glick, Ira D. M.D. 4 Psychiatric Conditions in Cosmetic Surgery Patients. Facial Plastic Surgery. 22(3):194-197, August 2006.

Elective plastic surgical procedures in adolescence.McGrath MH - Adolesc Med Clin - 01-OCT-2004; 15(3): 487-502 (reviews recent statistics, includes section on Patient Selection)

Habal MB. Pediatric plastic surgery as a superspecialty of plastic surgery. [Editorial] Journal of Craniofacial Surgery. 14(4):427-8, 2003 Jul. UI: 12867850

Simis KJ. Hovius SE. de Beaufort ID. Verhulst FC. Koot HM. After plastic surgery: adolescent-reported appearance ratings and appearance-related burdens in patient and general population groups. [Journal Article. Research Support, Non-U.S. Gov't] Plastic & Reconstructive Surgery. 109(1):9-17, 2002 Jan. UI: 11786785 (Assessment of post op patient satisfcation, included both reconstructive and cosmetic procedures in plastic surgery group, most satisfied: cosmetic breast surgery teenage patients)

Pearl A. Weston J. Attitudes of adolescents about cosmetic surgery. [Journal Article] Annals of Plastic Surgery. 50(6):628-30, 2003 Jun. UI: 12783017 (survey of California high school students- attitude slightly more negative than adults, teenagers against cosmetic surgery see reasons to have:vanity, teenagers in favor see reason to have:motivation, social ambition)

Honigman RJ. Phillips KA. Castle DJ. A review of psychosocial outcomes for patients seeking cosmetic surgery. [Review] [62 refs] [Journal Article. Review] Plastic & Reconstructive Surgery. 113(4):1229-37, 2004 Apr 1. UI: 15083026

Smoking

Netscher DT. Clamon J. Smoking: adverse effects on outcomes for plastic surgical patients. [Journal Article] Plastic Surgical Nursing. 14(4):205-10, 1994. UI: 7732100

Rohrich RJ. Coberly DM. Krueger JK. Brown SA. Planning elective operations on patients who smoke: survey of North American plastic surgeons.[see comment]. [Journal Article] Plastic & Reconstructive Surgery. 109(1):350-5; discussion 356-7, 2002 Jan. UI: 11786838

Coagulopathy

Borud LJ. Matarasso A. Spaccavento CM. Hanzlik RM. Factor XI deficiency: implications for management of patients undergoing aesthetic surgery. [Journal Article] Plastic & Reconstructive Surgery. 104(6):1907-13, 1999 Nov. UI: 10541197

Norms & Preferences

Goldstein SM. Katowitz JA. The male eyebrow: a topographic anatomic analysis. [Journal Article] Ophthalmic Plastic & Reconstructive Surgery. 21(4):285-91, 2005 Jul. UI: 16052142

Craig SB. Faller MS. Puckett CL. In search of the ideal female umbilicus. [Journal Article] Plastic & Reconstructive Surgery. 105(1):389-92, 2000 Jan. UI: 10627008

Deguchi M. Iio Y. Kobayashi K. Shirakabe T. Angle-splitting ostectomy for reducing the width of the lower face. [Journal Article] Plastic & Reconstructive Surgery. 99(7):1831-9, 1997 Jun. UI: 9180706 (rounding of square face:Osaka, Japan)

Kane AA. Lo LJ. Chen YR. Hsu KH. Noordhoff MS. The course of the inferior alveolar nerve in the normal human mandibular ramus and in patients presenting for cosmetic reduction of the mandibular angles. [Journal Article] Plastic & Reconstructive Surgery. 106(5):1162-74; discussion 1175-6, 2000 Oct. UI: 11039388(Cosmetic reduction contouring of the mandibular angles is a common surgical procedure (particularly among Asian women) performed in response to a complaint of “square face.”)

Bashour M. An objective system for measuring facial attractiveness. [Comparative Study. Journal Article] Plastic & Reconstructive Surgery. 118(3):757-74; discussion 775-6, 2006 Sep. UI: 16932187

Rhinoplasty

Changing fashion from "Northern European Nose"

Richard E. Davis: Rhinoplasty and Concepts of Facial Beauty.Facial plast Surg 2006; 22: 198-203DOI: 10.1055/s-2006-950178

Complications

Baran CN. Tiftikcioglu YO. Baran NK. The use of alloplastic materials in secondary rhinoplasties: 32 years of clinical experience. [Journal Article] Plastic & Reconstructive Surgery. 116(5):1502-16, 2005 Oct. UI: 16217502-largely about iatrogenic deformities from overreduction- like saddle nose defect- corrected with implant materials, like proplast.

Benefits of Cosmetic Surgery

Khan JA. Aesthetic surgery: diagnosing and healing the miscues of human facial expression. [Review] [6 refs] [Journal Article. Review] Ophthalmic Plastic & Reconstructive Surgery. 17(1):4-6, 2001 Jan. UI: 11206743 (preventing miscues- hooded eyes etc signalling boredom, fatigue)

Specific risks Cosmetic Surgery (Complications)

Araco A. Gravante G. Araco F. Delogu D. Cervelli V. Capsular contracture: results of 3002 patients with aesthetic breast augmentation.[comment]. [Comment. Letter] Plastic & Reconstructive Surgery. 118(6):1499-500; author reply 1500-2, 2006 Nov. UI: 17051132

Neck

Rohrich RJ. Rios JL. Smith PD. Gutowski KA. Neck rejuvenation revisited. [Review] [30 refs] [Case Reports. Journal Article. Review] Plastic & Reconstructive Surgery. 118(5):1251-63, 2006 Oct. UI: 17016198 (Ellenbogen and Karlin 10 established five visual criteria that are characteristic of the youthful, aesthetic neck in their postoperative rhytidectomy patients: (1) a distinct inferior mandibular border from mentum to angle, with no jowl overhang; (2) subhyoid depression; (3) visible thyroid cartilage; (4) visible anterior border of the sternocleidomastoid muscle, distinct in its entire course from mastoid to sternum; and (5) a cervicomental angle between 105 and 120 degrees (90-degree sternocleidomastoid to submental line).)

Calves

Lee JT. Wang CH. Cheng LF. Lin CM. Huang CC. Chien SH. Subtotal resection of gastrocnemius muscles for hypertrophic muscular calves in Asians. Plastic & Reconstructive Surgery. 118(6):1472-83, 2006 Nov. UI: 17051122 (references idea of "ideal female leg", presents method of resecting head of gastrocnemius muscle in Asian women with well-developed calf muscles, as opposed to liposuction for fat)

Genitals

Choi HY. Kim KT. A new method for aesthetic reduction of labia minora (the deepithelialized reduction of labioplasty). [Journal Article] Plastic & Reconstructive Surgery. 105(1):419-22; discussion 423-4, 2000 Jan. UI: 10627011 (Korea-claim that reduces embaressment in bath houses)

Munhoz AM. Filassi JR. Ricci MD. Aldrighi C. Correia LD. Aldrighi JM. Ferreira MC. Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction. [Evaluation Studies. Journal Article] Plastic & Reconstructive Surgery. 118(5):1237-47; discussion 1248-50, 2006 Oct. UI: 17016196 (21 patients underwent aesthetic surgical reduction of the labia minora at the Hospital das Clínicas, University of São Paulo School of Medicine, and the senior authors' (A.M.M. and J.R.F.) private practice. Surgical treatment was requested by the patient, who sought surgical correction for a better labia minora appearance and functional problems. The reasons for surgical treatment varied and were as follows: aesthetic complaints, 21 patients (100 percent); interference with sexual intercourse, 13 (61.9 percent); poor hygiene, 10 (47.6 percent); and difficulty wearing tight-fitting pants, 7 (33.3 percent) )

Body Recontouring

Rohrich RJ. Gosman AA. Conrad MH. Coleman J. Simplifying circumferential body contouring: the central body lift evolution. [Journal Article] Plastic & Reconstructive Surgery. 118(2):525-35; discussion 536-8, 2006 Aug. UI: 16874230 (The "central body lift")

Stevens WG. Cohen R. Vath SD. Stoker DA. Hirsch EM. Is it safe to combine abdominoplasty with elective breast surgery? A review of 151 consecutive cases. [Comparative Study. Journal Article] Plastic & Reconstructive Surgery. 118(1):207-12; discussion 213-4, 2006 Jul. UI: 16816696

Liposuction

Esposito K. Giugliano G. Scuderi N. Giugliano D. Role of adipokines in the obesity-inflammation relationship: the effect of fat removal. Review] Plastic & Reconstructive Surgery. 118(4):1048-57; discussion 1058-9, 2006 Sep 15. UI: 16980868 (review obesity/metabolic syndrome/liposuction)

Soft tissue fillers

von Buelow S. Pallua N. Efficacy and safety of polyacrylamide hydrogel for facial soft-tissue augmentation in a 2-year follow-up: a prospective multicenter study for evaluation of safety and aesthetic results in 101 patients. [Clinical Trial. Journal Article. Multicenter Study] Plastic & Reconstructive Surgery. 118(3 Suppl):85S-91S, 2006 Sep. UI: 16936548

Coleman SR. Structural fat grafting: more than a permanent filler. [Case Reports. Evaluation Studies. Journal Article] Plastic & Reconstructive Surgery. 118(3 Suppl):108S-120S, 2006 Sep. UI: 16936550

Skin resurfacing

Laser

Geronemus RG. Fractional photothermolysis: current and future applications. Lasers Surg Med. 2006;38:169-176

Collawn, Sherry S. MD, PhD. Fraxel Skin Resurfacing. Annals of Plastic Surgery. 58(3):237-240, March 2007

Concerns

I like the article but I have a slight concern that in places the tone of the article appears to verge towards promoting cosmetic surgery. I think we need to be very careful not to seem to promote any treatment. There is some great science on the aesthetics of faces, I'll try to look it up.

Previously, the comment was made that the article seemed to be against cosmetic surgery. Personally, I think I'm fairly neutral, yet it's hard to walk the line. I changed a lot of the general advice about patient selection to a more neutral "this is what training programs advise", because that was important to do, to avoid the appearance of an opinion piece. The article is still early on. Perhaps you could copy and insert some of the specific [places that concern you here on the talk page? Maybe I (or others) can figure a way to counter act them. Nancy Sculerati MD 11:29, 1 March 2007 (CST)

My comment was really to explain some of my edits; where I was concerned I tried to reword, I was just alerting you to that as an explanation. I guess though that repeated mention of "safe and effective" is something to avoid; it's said early on in a balanced way, so repeating it seems promotionalGareth Leng 11:54, 1 March 2007 (CST)

Rearrangement? I'd suggest making the first subsection part of the introduction, and then repeating it at the beginning of the risks section to help the flow.Gareth Leng 05:49, 2 March 2007 (CST)

Go ahead and do so, Gareth. It's not clear to me what you have in mind, please show me?Nancy Sculerati MD 07:05, 2 March 2007 (CST)

Also, the science that I know that is related is not exactly aesthetics, but it probably lays behind much of aesthetics-it's the specific physical facial correlates to communicating emotion by expressions, (lowered v raised eyebrows etc) and also the specific pediatric features-large eyes, low ratio of mid/lower face to forehead, that are hard-wired in to us to produce emotional responses. I think a whole article on that would be great-and would link here nicely. Interested to see what you find! Nancy Sculerati MD 07:25, 2 March 2007 (CST)

I was thinking of the study in Nature that morphed faces and asked subjects to rate their attractiveness, I'll try t find them. BTW this sounds interesting: haven't got the full text. Semin Cutan Med Surg. 2003 Jun;22(2):79-92. Sarwer DB, Grossbart TA, Didie ER. PMID 12877227 "Beauty is an abstract construct. We all have our own ideas about what is and is not beautiful--a particular song or painting, a man or woman. Accurately describing what exactly "it" is that makes the song, painting or person beautiful, however, is a daunting task. In this article, we attempt to make the case that beauty and physical attractiveness is a serious matter. We begin with a discussion of the role of beauty in evolutionary theory. Next, we turn to theories of the physiology of beauty, which focus on physical characteristics such as pathogen resistance, averageness, physical symmetry, body ratios, and youthfulness. We then describe changes in the societal standards of beauty through a discussion of the relatively recent history of mass media images of beauty. We then use the psychological construct of body image to begin to understand the nature of beauty on an individual level. The article concludes with a discussion of the things that we do to make ourselves more beautiful." Gareth Leng 08:20, 2 March 2007 (CST)

Found it: Effects of sexual dimorphism on facial attractiveness. Perrett DI, et al. Effects of sexual dimorphism on facial attractiveness. Nature. 1998 Aug 27;394(6696):884-7. PMID 9732869 Testosterone-dependent secondary sexual characteristics in males may signal immunological competence and are sexually selected for in several species. In humans, oestrogen-dependent characteristics of the female body correlate with health and reproductive fitness and are found attractive. Enhancing the sexual dimorphism of human faces should raise attractiveness by enhancing sex-hormone-related cues to youth and fertility in females, and to dominance and immunocompetence in males. Here we report the results of asking subjects to choose the most attractive faces from continua that enhanced or diminished differences between the average shape of female and male faces. As predicted, subjects preferred feminized to average shapes of a female face. This preference applied across UK and Japanese populations but was stronger for within-population judgements, which indicates that attractiveness cues are learned. Subjects preferred feminized to average or masculinized shapes of a male face. Enhancing masculine facial characteristics increased both perceived dominance and negative attributions (for example, coldness or dishonesty) relevant to relationships and paternal investment. These results indicate a selection pressure that limits sexual dimorphism and encourages neoteny in humans.Gareth Leng 08:33, 2 March 2007 (CST)

I like the changes you made about moving risk around. There are cultures in which surgery for pure cosmesis is not condoned, and this probably should be mentioned also. I just have to be sure of my facts before I add a line or two. Nancy Sculerati MD 09:28, 2 March 2007 (CST)

On liposuction, I think it is probably important to specify that this is not a procedure that has sustained effectiveness for reducing body weight. Gastric bypass surgery is effective, but I think is not done for cosmetic reasons because of the risks. Gareth Leng 11:38, 2 March 2007 (CST)

Again a caution, I think it's easy to slip into phrasing that in several respects is dodgy; for example, talking of "correcting" ethnic features seems to accept that they are deformities. Do we have statistics on use of cosmetic surgery?Gareth Leng 03:12, 4 March 2007 (CST)

None of the statistics are really more than estimates, there are some surveys of specific groups (like members of a particular society), but since cosmetic surgery is not "reportable", and is not only almost never financed by third-party plans or insurers, but is also often financed in cash, there are no real statistics. I will add some numbers with references under the reference section today. As far as the ethnic "corrections" go, as you probably already know, I strongly believe that they are not corrections at all, but since that subject is really at the core of facial cosmetic surgery it really must be addressed. Facial appearance surgery really seems to have developed from two guiding desires by patients and doctors-to be whole, and beautiful. The "whole"part came from the correction of deformities that are not subjective. For example, a thousand years ago there were criminal punishments in parts of the world of cutting off the soft part of the nose as a punishment for a crime. Some of the first plastic operations were cutting a tissue flap from the forehead and fastening it down to cover the open wound, and make a semblence of a nose. That's reconstructive surgery, and many of the techniques of the reconstructive operations (all over the body) came to eventually be applied in cosmetic ways. Now as far as the be beautiful part, beauty is at least partly defined by looking like "high class" people at the upper strata of society. There are some articles I have found that talk about trends to want eatures associated with royal families, for example. All cosmetic facial surgeons are familiar with patients that come to the ofice with pictures of movie stars, and that is also mentioned in many journal articles. The section on rhinoplasty, which focuses on this the most, is not finished. As you probably know, I have an idea that is only partly fleshed out. Let me explain it here:The high bridged, narrow nose of a certain ideal type that was the typical result of cosmetic rhinoplasty in the 1950's and 1960's is very much a Northern European type nose. For one thing, the underlying structure is of a relatively high proportion of the upper nasal bones to the cartilage that makes up the lower nose, and the detailed contours around the nostrils and bridge require a thin covering of skin to show. With thick skin, even if the underlying structure is just the same, the result is different, and there is less sculptured detail. Anyway, in he last 20-30 years as implant material got used, people with thicker skin had implants placed under the skin to raise the profile and give more definition. In the beginning, this was done quite aggressively by some of the most careful plastic surgeons because the immediate results looked good. The terrible complications came later. I don't say that Michael Jackson had such surgery, but the picture of him from the mid-80's in the article that shows a straight high profile nose is typical of one of the really good results. I included that picture to show such a good result. Since a number of ethnic groups, including most of the sub-Saharan African noses, tend to be built with more cartilage and less bone, to get that look something has to be put under the skin of the nose (an implant) to give the high straight line which, in those groups that have it naturally, is made of bone. The synthetic implants can get infected, and put pressure against the skin of the nose and there have been many cases where people have had them extrude through the skin of the nose, leaving scars and tissue loss, even, in extreme cases, loss of the lower nose. If you look through the literature-which is mostly case reports and series of cases, most of the patients that suffer this are not of European ancestry- I don't think that's a bias in reporting- I think that's because to get that desired look with, say, an average Indonesian nose, a big implant is needed, and that's what puts the skin and cartilage at risk. Meanwhile, with people with thin skin (primarily a subsection of people of European ancestry), the desire for that nose leads to another set of complications: first, the lateral osteotomes to narrow the nose are not obvious post-rhinolasty except in thin skinned people, and in them often not until decades after the rhinoplasty, when there is loss of dermal collagen and elastin with normal aging-and suddenly they appear, these crooked vertical lines on either side of the nose. Also, nostrils are shaped by skin and cartilage, and if too much cartilage is removed to get that "refined" look, then the skin-if thin- is especially unlikely to give support to the shape and there is a pinched collapse. The dorsal hump that was identified in the 50's and before as being typical of a Jewish nose(as well documented in the refernces I quoted) was considered by pateients and surgeons of those times something to be "corrected", and its aggressive removal- in Jews and anybody else that had a hint of one-led to the famous "ski jump" contours of the typical post-rhinoplasty nose of the 50's and 60's. That nose was actually desired by many patients, it was sort of a status symbol of having had plastic surgery. Whatever the aesthetics, which are always subjective, when too much bone or cartilage is removed, over time, the nose tends to collapse.Thoughout the cosmetic surgery literature there is an assumption stated by plastic surgeons that the celebrities of a time are a good indication of popular standards of beauty. If you compare the faces of movie stars of the 1930's with movie stars of today, in terms of leading men and ladies, there is no questions that there are many more looks than the more or less single ideal of Northern European beauty in the early 20th Century. A rounder, less high bridged nose has become more ideal, and the less aggressive reduction rhinoplasty techniques to get variations of it that fit the face are theoretically less likely to lead to soft tissue loss, exposure of fracture lines, and nasal collapse. This is actually a benefit of having a more inclusive society. I'll come up with a bunch of references- somne are already there-most of the rhinoplasty references I have listed refer to at least some of these points. Nancy Sculerati MD 06:28, 4 March 2007 (CST)