Cosmetic surgery: Common cosmetic surgery procedures: iVillage

The market research company Mintel estimates that some 72,000 cosmetic surgery procedures took place in Britain last year. But before you rush to reinvent yourself, read our no-nonsense guide and find out what's really involved

Ten years ago it would have been unheard of to think about cutting open your face and pinning your facial muscles into place, injecting a poison into your forehead or moving your nipple a few inches higher all in the name of vanity. These days, however, such procedures are becoming more and more commonplace.

In fact, the cosmetic surgery quest is now so popular among certain groups that there are even Botox parties along the lines of the old Tupperware variety, where groups of women arrange a get-together and invite a surgeon to administer their injections en masse.

But one of the problems with the demand for cosmetic surgery is the number of 'cowboy clinics' offering quick-fix procedures at the hands of surgeons who aren't registered by the General Medical Council. According to Professor David Sharpe, former president of the British Association of Aesthetic Plastic Surgeons (BAAPS), these kinds of clinics are on the rise. 'The only two UK associations whose members are all GMC-registered are BAAPS and The British Association of Plastic Surgeons,' he says.

No guarantees
There are two main forms of cosmetic surgery: invasive and non-invasive. However, 'even less involved techniques like chemical peels, laser surgery and botox injections, non-invasive but very popular, still require a qualified surgeon and there is no reason to take these procedures less seriously,' says plastic surgeon and BAAPS member Dr. Nick Percival from London's Stamford Hospital. He goes on to say that even with a chemical peel, a popular non-invasive procedure, you're basically painting someone's face with a type of acid, so it's still a serious procedure.

Percival also notes that not everyone who comes in to have a procedure is what doctors deem 'treatable'. For example, surgeons first interview patients to see what their expectations are. If they're going through a tough time or the surgeon feels they have unrealistic expectations of what surgery can offer, he or she can refuse treatment. 'People need intensive consultation for any treatment. I only treat around 75 per cent of the patients I initially see, often because they may be too psychologically vulnerable,' says Dr. Percival. He adds, 'We don't like operating on people going through a crisis, for example. We'll refer them for counselling instead.'

One reason surgeons sometimes refuse treatment is that 'nothing is guaranteed with any sort of cosmetic surgery,' says Professor Sharpe. 'Scars from surgery can be as thin as a pencil-line or thick as a pencil. It depends how an individual patient scars.' And any operation involving general anaesthesia carries an extra risk.

If you're still willing to consider a cosmetic procedure, here's an overview of your options:

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Call free on 0800 434 6644 to request a brochure, or to book an appointment with a consultant surgeon.

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How it works: If you've ever overdone it on the beach and watched your skin come off in sheets, you're halfway to understanding the principle behind cosmetic peeling. This procedure involves painting an acid solution on the skin and, depending how deep you want the peel to go, you can choose from a 30 per cent or 70 per cent strength glycolic acid peel.

The solution is left on for however long your skin can manage, then the doctor simply washes it away with water. For an even deeper peel, trichloric acid may be required. This is applied in much the same way, but is much more intense and requires a neutralising gel for removal.

Effects and side effects: Needless to say, chemical peeling isn't one of those procedures you can have at lunchtime and then return to work without anyone noticing. Depending on the degree of peel you have, you're likely to be laid up for a while. 'A peel is like a very severe sunburn effect,' says Dr Percival. 'After two or three days the skin goes very dry and literally starts to peel. The deeper the peel, the longer the skin takes to come off.'

Chemical peeling can remove all kinds of blemishes, including sun damage and signs of ageing. However, with particularly strong peels there is a potential risk of scarring.

How it works: Botox is recommended for lines around the eyes, between the eyebrows and on the forehead. An injection of this botulinium toxin - a much diluted form of toxin from the bacteria that causes botulism - works by chemically relaxing face muscles and preventing the creases and wrinkles formed by common expressions like smiling and frowning.

A series of small injections are administered to the specified area and the toxin sets about paralysing muscles and nerves. The procedure is considered one of the safest types of cosmetic medicine, as it doesn't involve cutting the skin.

Effects and side effects: 'It often takes two or three days to get the full effect,' says Professor Sharpe. He warns, however, that these injections aren't necessarily as reliable as you might think. 'Sometimes it doesn't work at all and you have to go back for a top-up,' he says.

When it does work, apart from limiting your facial expressions, the only pitfall is that it won't last long. To keep your furrowed brow in check, you'll be hotfooting it back to the clinic every few months.

How it works: For perfect pouts, temporary injectables like collagen, hyalurionic gel or even your own fat are injected or threaded into the lip. The most common procedure needs no anaesthetic and involves injecting collagen into the upper lip to achieve what's known as the 'Paris lip'. The other injectables involve a more complex procedure, using a threading technique with a needle and performed under local anaesthetic. Results last up to six months, but to maintain 'the look' you'll need another injection after that.

For permanent results, you can opt to use your own tissue. Extracted from a tendon in your wrist or mouth, or even from leftover skin from another operation you're having (some people will book in for a whole cocktail of ops in one go), the tissue will then be threaded into the lip. Other permanent alternatives include using a substance called Artecoll.

Effects and side effects: Risks of this type of procedure include infection from the needles, as the mouth is a difficult area to keep thoroughly clean. Also, your own fat may not 'take', and you could get lumpy results or a 'rubberised' effect - which leaves you with more of a plastic than a perfect pout.

How it works: It may sound very James Bond and state-of-the-art, but laser treatments are, in fact, becoming less popular than they once were. 'For all-over facial rejuvenation, peels are now more common than laser treatments, as the recovery time is quicker. Lasers are deeper and more aggressive, and skin can be a red colour for up to three months afterwards. But, they're ideal for smaller areas that need more intensive treatment,' says Dr. Percival.

During a treatment, the laser will be passed over your face, burning the skin in small circular motions, and most procedures will involve two or three passes to make sure the skin is evenly treated. For all-over facial resurfacing, you'd need a general anaesthetic. But, according to Professor Sharpe, you may well be glad to miss the smell of your own burning flesh. For smaller areas, a general anaesthetic won't be needed.

How it works: The technique is pretty simple - a small incision is made in the skin, then a hoover-like instrument sucks out the fat. It sounds disgusting and it isn't always successful. 'There are those it works well on and those it can't help at all,' says Dr. Percival. He warns that if you have very loose, thin skin and you take out a lot of fat, you're left with several sagging rolls of skin. What's more, the older or heavier you are, the less likely your skin is to spring back into shape.

Dr. Percival adds: 'there's a common misconception that liposuction can help people who are obese or overweight, when it's really only for reducing localised areas of fat.'

Effects and side effects: With a 30 per cent chance of needing a follow-up operation, liposuction is commonly regarded among industry professionals as the cosmetic operation most likely to disappoint.

How it works: An incision is usually made around the back of the ear, from the hair line down to the lobe in between the groove between the back of the ear and the bone behind. The skin is then pulled back and 'redraped.' Excess skin is removed, and the tightened skin is sewn back into its new position.

Effects and side effects: The procedure will tighten loose skin in the neck, face and around the corners of the mouth. Glamorous granny images notwithstanding, this is a surprisingly complex operation, and there's risk of damage to the fine nerves that work the facial muscles.

How it works: This is by far the most controversial of all cosmetic surgery procedures, and there is much debate about the safety of silicone implants. After lots of studies and a short-term US embargo on the use of this most popular procedure, there's still no scientific evidence that they're harmful. 'The worst complication is a seven to eight per cent risk of scar tissue thickening, which hardens the implant,' says Dr Percival. Other known risks include decreased nipple sensation, and the operation usually needs repeating every 10 years.

There are three different types of incision: under the arm, around the nipple and underneath the breast. Alternative implants include saline, which became the popular during the silicone scare in the US.

Effects and side effects: 'There is a quite high instance of leaking with the saline implants, and they wrinkle a lot,' says Professor Sharpe. 'And because they have to be over-inflated, so that the internal edges of the shell don't fracture, they can have a slightly unnatural appearance,' he adds.

All other implants, including the soya and hydrogen gel types, have been banned in the UK due to risk, non-reliability or lack of information about their long-term effects.

How it works: The most common technique involves moving the nipple up, reducing the breast tissue and tightening the skin underneath. Scarring is more prominent with reduction than with breast augmentation. An anchor-shaped incision is made around the areola, to look like a keyhole. The nipple is then moved, yet still attached to the breast, and fat is removed from underneath. Then, the whole shape is restitched, leaving an anchor-shaped scar. Risks include loss of nipple sensation and infection, and women can't breastfeed afterwards.

How it works: This usually involves lifting breast tissue and skin, and it can cause the same prominent anchor-shaped scarring as in reduction. The idea is to sling the breast up by removing tissue from underneath the breast itself. For very minor lifts, the surgeon may choose a donut mastopexy, involving a circular incision around the nipple. The skin around the nipple will then be pleated and bunched up, but will eventually iron itself out naturally. Both procedures can cause alteration in nipple sensation.

How it works: A favourite among twenty-somethings who've been saving their pennies to spite their nose. Results of this surgery depend on how much the nose needs remoulding, so scarring will vary. For nose-reshaping, cartilage and bone will be cut and discarded in order to reshape the nose's bridge line. In most cases the nose will then be broken in four places, and cartilage will then be chiselled into shape around the breaks. Finally, the tip of the nose will be altered by moving cartilage around in the nostrils.

Effects and side effects: Using saws, grafts and chisels, success is almost entirely reliant on the skill of your surgeon. Even with the most experienced specialist you may wake up looking like you've gone three rounds with Frank Bruno, and it could take up to three months for swelling to go down.

How it works: This is designed to tuck away unsightly rolls of skin. A large incision is made from hip bone to hip bone, then the skin is lifted up. 'It's rather like going under the bedsheets,' says Professor Sharpe. The fat underneath is cut out all the way up to the ribs, around the tummy button. Then the loosened skin is pulled tight, so that the piece of skin that was next to your tummy button before moves down to where your pubic hairline was. Finally, the extra skin is discarded. Before that's done though, though, you tighten up the muscles by pleating the fascia, or fibrous tissue, over the muscles to tighten up the abdominal wall.

Effects and side effects: 'Risks include a long scar across the stomach, numbness of the tummy wall and a five per cent chance of infection,' says Sharpe.

How it works: By far the most gruesome-sounding of all cosmetic procedures, this involves making four incisions above the hairline and under the scalp. A small telescope (endoscope) is used to work under the surface of the skin, lifting it off the bone. Skin is then pulled upwards and fixed into place with small screws in the skull for two to three weeks. They are removed once the skin has reset itself in its new position. Risks are minimal, and scarring is usually obscured by hair.

How it works: After a long night out, you may think the only way to get rid of those bags is by resorting to surgery. And since gravity will always have its evil way, eye bags tend to get worse with age. With upper-eye surgery, the incision runs along the crease in the eyelid from the inner aspect of the eye to about a centimetre

further than the eyebrow and, again, is almost unnoticeable. Fat is then removed from underneath the muscle and the inner corner of the eye.

Under-eye surgery also involves taking fat from underneath the muscle, this time working from inside the lower lid. 'Bags are caused by fat coming through the muscle,' says Professor Sharpe, 'and as you get older the fat tends to bulge through more, causing the muscle to stretch.'

Effects and side effects: Blepharoplasty boasts some of the best results in hidden scarring (under the eyelid).

Further details
Now that you know what's involved with the various cosmetic surgery procedures, how do you find a reputable doctor or surgeon to trust? For advice on surgeons and procedures, or for a referral, contact:

The British Association of Aesthetic Plastic Surgeons
The Royal College of Surgeons of England
35-43 Lincoln's Inn Fields
London WC2A 3PN
Tel: 020 7405 2234
Website: www.baaps.org.uk
Email: info@baaps.org.uk

The British Association of Plastic Surgeons
The Royal College of Surgeons of England
35-43 Lincoln's Inn Fields
London WC2A 3PN
Tel: 020 7831 5161/2
Website: www.baps.co.uk
Email: secretariat@baps.co.uk

For information on a particular surgeon's qualifications, contact:
The General Medical Council
178 Great Portland Street
London W1W 5JE
Tel: 020 7580 7642
Website: Website: www.gmc-uk.org
e-mail: gmc@gmc-uk.org