More than SKIN DEEP Puebloans take advantage of cosmetic procedures that are accessible and affordable

Thirty years ago, cosmetic plastic surgery wasn't a topic of everyday conversation. It was still somewhat foreign to the public at large, something primarily done by the very wealthy and not discussed much, by them or anyone else.

And then . . .

"Extreme Makeover."

Michael Jackson.

TLC's medical programs.

Dolly Parton.

"Dr. 90210."

The Internet.

"Nip/Tuck."

Michael Jackson, version 4.0.

Now plastic surgery is front and center, not just in the celebrity universe, but in the everyday world. Tummy tucks, face-lifts, breast augmentations: People know a lot about them and aren't hesitating to have them done - Pueblo residents included. In 2005, $12.4 billion was spent on elective cosmetic procedures, according to the American Society of Aesthetic Plastic Surgery. Ninety-one percent of those procedures were performed on women.

Here's one bit of information about the term itself: "plastic surgery" comes from the Greek word plastikos, which means to mold or give form.

Drs. Donald Luebke, Charles Kessler and Philip Marin, Pueblo's three plastic surgeons, all said that the increasing publicity about cosmetic surgery means people who come in for consultations already have gathered plenty of information.

"Most patients are well-read and have a fairly good database of knowledge," said Marin. "(Media exposure) desensitized the American population. They understand the process, so it creates a level of acceptance."

Marin said the baby-boomer population, in particular, is driving the plastic surgery trend.

"They're wanting to work longer and are competing with younger people," he said. "That in itself has increased the number of procedures nationwide."

Locally, breast augmentation and liposuction are the most common procedures; abdominoplasty, or tummy tuck, and eyelid surgery are two other popular choices.

"I did my first implant 30 years ago," said Luebke, who's been practicing in Pueblo since 1979.

Silicone implants were the norm until the early '90s, when problems arose with them. For now, surgeons use saline-filled implants, but a new, redesigned silicone version - already used for breast reconstruction in cancer patients - is expected to be approved for all surgeries soon.

"It's a cohesive gel implant. It doesn't leak; you can actually cut it in half. They call it the gummy-bear implant," said Luebke.

Another relatively new feature is adjustable implants. Several ounces of air can be added or removed through a tiny valve, which is eventually removed.

Kessler said he's seen an increase in the number of young women who want implants, but middle-aged patients are still more common.

"Usually, they've had children and now want to have something done, either an augmentation or something to correct sagging," he said.

JoAnn Schlegel, the clinic supervisor for Drs. Kessler and Marin (who share an office), is a nurse and has worked for plastic surgeons for 25 years. She's also been a patient. Her first procedure was rhinoplasty (nose job), then eyelid work and finally, in 1985, breast implants.

Schlegel said she's happy with the results of all three surgeries, but has one emphatic piece of advice for anyone thinking about cosmetic surgery.

"It's something you have to do for yourself, not anybody else," she said.

Most surgeries can be done on an outpatient basis, although some require overnight stays. There are three costs associated with cosmetic surgery: surgeon, anesthesiologist and facility fees. There have been recent news stories about plastic surgeons attempting to cut costs by attempting to administer anesthesia themselves; Kessler, Luebke and Marin all urge patients to get as much professional information about a doctor as possible before deciding to have a procedure done.

Ideally, a surgeon will be board certified, which indicates extensive training, and be a member of the American Society of Plastic Surgeons. All three Pueblo doctors have those qualifications.

"Safety is very important in all of this," said Marin. "You're doing stuff that's elective."

"If it's not safe, nothing is worth doing," said Kessler.

Patients shouldn't expect to walk in, tell a doctor what they want and proceed straight to the operating room. There's an initial consultation, in which the patient explains what they'd like to improve about their body and why. If the doctor agrees to perform the surgery, there's still an extensive pre-operative screening and medical clearance to be done before the procedure can take place.

Good candidates for cosmetic surgery have a strong self-image but are bothered by a physical characteristic they'd like to improve, or have a flaw that has diminished their self-esteem over time, according to the American Society of Plastic Surgeons. Patients who are in crisis, obsessed with a very minor defect, impossible to please or have unrealistic expectations aren't suitable candidates.

Marin said it's rare that he refuses to perform a procedure, but it does happen. And anyone looking to have a deep-plane face lift, which can severely alter a person's facial features (Kenny Rogers, for example), would probably have to find another surgeon.

"I don't like that look. It's just not right," he said. "You've still got to preserve a natural appearance - a refreshed, rejuvenated look."

Luebke said age is another consideration. He calls the trend of high school-age girls getting implants or liposuction "nuts" and sets a minimum age of 18 for many cosmetic procedures. "You have to be mature about your body image and many younger patients just aren't," Luebke said.

Of course, surgery isn't always required for cosmetic procedures. Sessions with injectable fillers like Botox and Restylane are performed quickly, with good results and few side effects, the doctors say.

"You can do it on your lunch hour and within a couple of days the frown lines are greatly improved, and they stay that way for three or four months. For someone who doesn't need major surgery, (Botox) can also improve crow's feet," said Luebke. "It's less expensive and relatively complication-free."

Kessler said laser resurfacing is used for wrinkles, brown spots and tatoo removal. It's also become useful for something the doctors would prefer not to see: skin cancer.

"I see a lot of it and lately we're seeing an explosion of melanoma," said Luebke, whose father died from the disease. "I beg people to stay out of tanning booths and avoid sunburns and exposure, especially when they're young."

Although there's a higher level of acceptance for cosmetic surgery, Pueblo's plastic surgeons have offices that offer a high degree of privacy. If patients want to share the news afterward, great, and many of them do.

"Some are private, but some want to spread the joy," said Schlegel.

Why not? They feel new and improved. Sometimes a cosmetic change is more than skin deep.

More than SKIN DEEP Puebloans take advantage of cosmetic procedures that are accessible and affordable

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