Cosmetic Surgery

Reality television actress Heidi Montag recently stirred controversy—and perhaps revived her career, such as it is, by reportedly having ten plastic surgery procedures performed in a single day. If possessing healthy beauty means liking what we see in the mirror, then perhaps this starlet's extreme makeover qualifies. But if it means feeling content when we look beyond the surface, then perhaps not. Only Ms. Montag can say for sure.

In moderation, plastic surgery can objectively improve a person's appearance and, more important, his or her confidence. But no nip and tuck, no matter how skillful, can mend the self-esteem of a person with deeply rooted insecurities related to his or her body, a condition known as body dysmorphic disorder (BDD). BDD, which affects one in five people who elect to have plastic surgery, is a disabling preoccupation with a perceived physical flaw. Legitimate plastic surgeons screen for unaddressed emotional disorders and will not perform procedures on those whom they suspect of having such difficulties. Instead, they will refer such patients for mental health counseling.

Plastic surgery (from the Greek word plastikós, meaning "that which can be molded"), or cosmetic surgery, is performed by doctors—usually plastic surgeons or dermatologists—who are specially trained and certified to perform cosmetic and reconstructive procedures. Keep these cautions in mind when you choose a doctor to perform your procedure:

• Be sure the procedure will be performed at an appropriate surgical facility. It can be an outpatient office with a surgical suite, rather than a hospital, but be sure the physician has privileges (that is, he or she is approved to practice) at a nearby hospital facility.
• Choose a physician who specializes in the procedure in which you're interested. A doctor who is good at sculpting the thighs with liposuction may not be equally adept at sculpting the nose.
• Look for a surgeon who is board certified by the American Board of Plastic Surgery or another recognized professional organization. Don't take the physician's word for it—confirm board certification, professional affiliations, and hospital privileges on the web or by phone.
• Beware! Any licensed physician in the United States may legally perform cosmetic surgery procedures even if he hasn't so much as attended a Botox party.

Although the weak economy has cooled demand, the field of cosmetic surgery is still flourishing, with total spending at $10.5 billion in 2009. Men now account for nearly 10% of cosmetic surgery procedures, such as liposuction, nose jobs, and eye lifts.

The variety of cosmetic concerns that can be satisfactorily addressed with plastic surgery continues to grow. Injectable dermal fillers and fat grafting procedures (transfer of one's own fat), for example, have made it possible to correct such seemingly minor problems as vertical lip lines. Fillers or grafting can add volume to scarred areas or resculpt thighs distorted by a bungled liposuction procedure. (See "Face" for information on Botox and more about dermal fillers.)

Virtually any flaw can be corrected, from loose skin under the arms—charmingly known as "batwings"—to a second toe that's longer than the first (corrected by removing bone in a procedure called a "toe tuck"). The following procedures are especially popular:

Breast reduction, enlargement, or lift

Changes the size and shape of breasts by removing breast tissue, inserting implants, changing the position of the nipple and areola, or some combination of these procedures. According to the American Society of Plastic Surgeons, breast enlargement has been the most popular procedure for the past 5 years.

Liposuction

Removes fat from the thighs, buttocks, abdomen, chin, or other areas.

Abdominoplasty, or "tummy tuck"

Flattens the abdomen by removing fat and tightening muscles.

Rhinoplasty

Makes the nose smaller or gives it more pleasing contours.

Ear procedures

Reposition protruding ears or recontour large or irregularly shaped ears.

Body contouring

Removes sagging skin after a large weight loss, such as following bariatric surgery.