Kinder Cuts

When you hear the call of cosmetic surgery- whether it’s a Botox injection or liposuction on those flabby thighs- there’s no need to head down to Manhattan. Valley doctors are just as qualified and cost a lot less.

Kinder Cuts


There¡¯s no need to travel to Manhattan for
cosmetic surgery. You can get the same quality services ¡ª at much more
reasonable prices ¡ª right here in the Valley

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by Anitra Brown


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These days you can¡¯t channel surf for more than a minute without coming across a plastic surgeon drawing lines around an aging rock star¡¯s eyes, sympathetically fingering a young woman¡¯s weak chin, or telling a middle-aged frump she¡¯ll be happy with the result.


¡°They¡¯re junk,¡± says Dr. Steven M. Lapidus from the Center for Body Contouring in Poughkeepsie, expressing his opinion of shows like Extreme Makeover and The Swan.


¡°They do a lot of flash-in-the-pan stuff so the people can be ogled at their coming-out party and cry and say how grateful they are.¡±

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Still, plastic surgeons concede that the shows have exposed Americans to the wide range of body-altering techniques available. And we are buying ¡ª to the tune of nearly 8.3 million cosmetic pro­­­­­­­cedures in 2003, a 20-percent increase over the previous year, according to the American Society for Aesthetic Plastic Surgery (ASAPS), a New York City¨Cbased nonprofit that keeps track of such statistics.


Things are no different in the Hudson Valley, where a relatively affluent populace is choosing to become more beautiful. ¡°My business is up 30 percent this year,¡± says Dr. John Farella, who practices in Westchester. ¡°People understand you don¡¯t have to go to Manhattan to get an excellent plastic surgeon. The training and the licensing is the same. The only real difference is the location and the price.¡±


Prices are less because the cost structures in the Valley are lower. ¡°The malpractice rates are cheaper up here,¡± explains Dr. Lapidus. ¡°The hospital or ambulatory surgery center is cheaper. Our real estate is cheaper. We pay our staff less. And the surgeons operate for less.¡±


How big is the price difference? ¡°A face-lift in the city will be $20,000, and in Albany you¡¯re looking at half that price,¡± says Dr. Douglas Hargrave of the Plastic Surgery Group. ¡°Entry-level liposuction in Albany is $5,000, and in New York City it¡¯s $8,000 to $10,000. Entry-level rhinoplasty in Albany is $5,000 to $6,000, and the top guys in the city are $15,000 to $20,000.¡± And if you think that a plastic surgeon is better simply because he has a New York City address, consider this: one of the biggest names in plastic surgery in the city trained in Albany.


¡°Women are under the illusion that if it¡¯s more expensive, it¡¯s better work,¡± says Linda Nicolo of Pretty Face Medi Spa in Montrose (Westchester), which offers Botox and Restylane administered by local plastic surgeons. ¡°That¡¯s definitely a fallacy. The difference between [the Valley¡¯s cosmetic surgeons] and a Park Avenue doctor is a really large rent.¡± Nicolo, who trained as a plastic surgical skin care specialist, recommends that your choice be guided by the doctor¡¯s credentials, his portfolio of work, and referrals. But no matter how demanding you are, you¡¯re likely to get a big price break in the Hudson Valley. ¡°Face and eyes in Westchester is $10,000, and in Manhattan it¡¯s $20,000,¡± she says.


Another reason more people are staying close to home is there are many more surgeons to choose from than in the past. ¡°There are seven plastic surgeons in Poughkeepsie,¡± says Dr. Lapidus, who specializes in liposuction and breast enhancement. ¡°There are two in Kingston, and Middletown, Newburgh, and Carmel all have two or three.¡±


The Plastic Surgery Group in Albany has seven surgeons who can combine resources to offer the latest equipment. But plastic surgeons are thickest on the ground in Westchester, where 21 doctors are affiliated with the Institute of Aesthetic Surgery and Medicine, an operating facility at Northern Westchester Hospital in Mt. Kisco. ¡°The ambiance is of a wonderful private office, where everything is quiet and unhurried, and the patient is the object of everyone¡¯s affection and attention,¡± says the institute¡¯s director, Dr. Philip C. Bonanno. Specialties include everything from ocular surgery to reconstructions after breast cancer.


What procedures are people choosing in the Hudson Valley? They mirror fairly closely the national numbers provided by the ASAPS, which breaks it down into nonsurgical procedures like Botox, laser hair removal, and medical microdermabrasion; and surgical procedures like liposuction, breast enlargements, and eyelid lifts.


Nonsurgical cosmetic procedures are the most common, commanding 78 percent of the market. And they¡¯re growing at a faster clip, as well ¡ª up 22 percent in 2003, compared to a 12 percent increase in surgical procedures. ¡°There¡¯s a whole host of nonsurgical things you can do to improve your appearance before you get a face-lift,¡± says Dr. Farella.


The big gorilla in that field is Botox, the toxin that paralyzes muscles so that you can¡¯t scowl or make other wrinkle-causing expressions. More than 2.25 million injections of Botox were administered in 2003, making it by far the most popular cosmetic procedure in the country. ¡°It¡¯s being driven in part by the companies,¡± says Dr. Farella. ¡°They¡¯re marketing directly to the consumer.¡± The largest market for Botox is women aged 35 and up.


The second most popular nonsurgical procedure is laser hair removal, a favorite of women age 19 to 34. Rounding out the top five nonsurgical procedures are medical microdermabrasion, which abrades fine lines and wrinkles using a powerful machine to spray high-grade microcrystals across the skin¡¯s surface; chemical peels, which tighten skin and increase collagen production; and collagen injections, which plump lips and fill in the deep creases and wrinkles that come from a lifetime of emotion. The up-and-coming products in the last category are Restylane and Radiance. ¡°They work better and last longer than collagen,¡± says Dr. Hargrave.


One effect of all these nonsurgical options is that women are delaying face-lifts or having smaller procedures. ¡°The face-lift used to be a one-operation-fits-all,¡± says Dr. Bonanno. ¡°Now the procedures can be targeted for the specific portion of the face that has suffered in the aging process.¡± In other words, a woman can just get what she needs ¡ª liposuction on a flabby neck, a mini-lift to tighten slackening skin, or a brow lift to open up the eyes.


What¡¯s hot in surgical procedures? ¡°Body contouring¡± ¡ª a.k.a. liposuction ¡ª was the most sought after, with 384,626 people undergoing the procedure in 2003. First runner-up was breast augmentation, which 280,401 women opted for. And rounding out the top five are eyelid surgery, nose jobs (or rhinoplasty), and breast reduction. Abdominoplasty (tummy tucks) are also gaining in popularity.


Each procedure seems to have its own market. Women age 35 to 50 choose liposuction above all other procedures, while breast augmentation is tops among women age 19 to 34. Women in the 51 to 64 age group are going in for eyelid surgery, while the 19-and-under crowd are getting nose jobs. Although women are by far the biggest users of cosmetic procedures, men are moving into the market. In 2003, they underwent 13 percent of all cosmetic procedures.


¡°The field that is exploding is post-bariatric skin contouring,¡± says Dr. Bonanno. He¡¯s

referring to the process of trimming and tightening the veils of excess fat on formerly obese patients who have undergone the ¡°stomach-stapling¡± procedure popularized by TV personality Al Roker. ¡°That¡¯s rapidly growing and we do a lot of it at the institute,¡± Dr. Bonanno reports.


No matter what body defect you¡¯re unhappy with, you can take care of it right here in the Valley. But plastic surgeons warn against thinking you¡¯re going to turn out like the Extreme Makeover case studies.


¡°The people in the shows are taking two or three months off,¡± says Dr. Farella. ¡°They¡¯re on diets. They have trainers. They have a psychological support team. They¡¯re getting their hair done, their nails done, their teeth done. They have makeup artists. People are making clothes for them. It¡¯s the whole package.¡± And the cost of all the procedures they¡¯re getting amounts to a small fortune. ¡°Just your teeth can be $40,000,¡± says Dr. Farella.


Besides the unrealistic expectations the shows raise, there are other, more serious concerns. ¡°These shows emphasize only the promise of plastic surgery without getting into the depth of a decision process,¡± says Dr. Lapidus. ¡°There are risks and complications. Surgeons aren¡¯t perfect. And each individual has a different biochemical, physiological, and mental make-up that you have to deal with.¡±

Ironically, one thing that increases the risk is having five or six procedures done at one time ¡ª something these Hudson Valley plastic surgeons wouldn¡¯t do. ¡°We know that the longer you stay under anesthesia, the higher your risk of complications,¡± says Dr. Bonanno. And recovery is much more difficult if the body has to recover from so many procedures at once.  ¡°You¡¯ll feel like you¡¯ve been run over by a truck,¡± says Nicolo of Pretty Face.


Finally, there¡¯s the ethical aspect. ¡°These shows are all about changing a person¡¯s looks dramatically, and it¡¯s rarely the best thing for patients,¡± says Dr. Hargrave of the Plastic Surgery Group in Albany. ¡°If there is some area that a person is dissatisfied with, it¡¯s gratifying to help. But our goal should be to get a good, natural look.¡± ¡ö



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