If you're over 40, you've been there: That face in the mirror -- it just isn't you anymore. Like a good house in an older neighborhood, it's time for remodeling.
"People have different motivations for plastic surgery, and sometimes they're realistic, sometimes they're not," says Michael Powell, MD, a facial plastic surgeon and consultant for WebMD.
Indeed, cosmetic surgery -- especially facial plastic surgery -- is a serious step. Here are some things to consider before you see a surgeon.
1. Your motivation. It's important that you already feel good about yourself -- that you just want to improve your self-image, refresh your face.
"You don't want to be thinking, 'I must have this surgery because it will give me a new life,'" Powell tells WebMD. "It has to be other way around -- I'm already comfortable with who I am, but my body image isn't right. I look old, angry, tired, and would feel more confident, feel better if I improved myself a bit."
Sometimes a little facial plastic surgery helps in the job market, Powell adds. "But you don't want the job to be a primary motivation. But if you're in sales, real estate, and you want to feel more competent, do a better job of presenting yourself, that's a good reason to have plastic surgery."
Also, the problem needs to be visible -- one that both you and the doctor can see, he says. "It's got to be a rational decision. It's not necessary for your emotional health, but a gift you give yourself because it will make you feel better," he says.
2. Your expectations. Facial plastic surgery won't make your husband or wife come back, and it won't make your employer rehire you. It also won't make you look like your favorite movie star.
Your bone structure, cartilage, and skin play into the end result. "We say we can make your nose look better on your face. We can take what you have and fine-tune it -- but we can't change your nose to someone else's," says Powell.
3. Your emotional state. If you're going through emotional trauma -- you just lost your spouse, got divorced, are depressed -- don't have cosmetic surgery. "Don't think it will pull you out of emotional trauma, because the surgery could make your depression worse," Powell tells WebMD.
Most people who have facial plastic surgery feel blue afterward, he explains. "Your face is swollen, bruised, you don't have as much energy because of the surgery and the anesthesia. If you're already depressed, you will feel worse. That can impact your healing -- since your immune system will be depressed, too. Your face will then take longer to heal."
4. Your support system. Because you'll feel blue, you need people backing up your decision, people who can see you through the rough times.
5. The expense. You don't want this surgery to add to any financial troubles, advises Powell. "If you trade one problem for another, that's not good. You've got to be able to afford it." One man told his wife: "You robbed our children's college funds." Don't go into facial plastic surgery with that hanging over your head.
6. The risks. Like any surgery, there are routine risks associated with anesthesia, blood loss, infections. But cosmetic surgery has specific risks -- there could be some asymmetry, a less-than-desirable outcome, slow healing. Are you prepared to deal with that?
"Just like anything in life, you have to have a little faith and be willing to follow through," Powell tells WebMD. "If you do have some sort of unexpected result, you have to be willing to give it time, be patient, work with your doctor."
Also, remember this: "A lot of problems look like big things at first, and some will go away or heal on their own. But if there is a problem, that's when the doctor-patient relationship needs to be strongest. Some patients you have big relationships with are the ones who had little problems. We had be partners, go through it together."
7. A second surgery. Some 15% to 20% of noses have to be redone, says Powell. "We always tell patients this might not be the only operation you'll have. Sometimes there's a little asymmetry, a little pucker. Some problems have to be fine-tuned. That's when it's important to have a good relationship with your doctor. You have to stick together, and if a revision is needed for the final result, be prepared to go for it."
8. Your vision. Do you have a clear idea of what you want? "We ask patients to bring in noses they like," says Powell. "Also, computer imaging helps; then there won't be miscommunication." But the surgeon may be hesitant to give a guarantee, he adds. "Some things that are possible in computer imaging are not possible in the operating room. The surgeon also has to have realistic expectations."
9. Your surgeon. Have you found one you like and trust? There are three professional associations: The American Society of Plastic Surgeons (the oldest group); the American Academy of Facial Plastic Surgery; and the American Academy of Dermatology (they do smaller procedures like chemical peels, dermabrasion, eyelid surgery.)
Each association can provide names of surgeons in your area.
"Look for experience in the specific procedure and reputation," Powell advises. "Don't believe advertising. Word of mouth from other satisfied patients works best."
Make an appointment for a consultation/interview. Interview two, maybe three surgeons, before you make your decision. Check out the doctor's waiting room. Perhaps there are brochures the surgeon has written. There may be before-and-after pictures. Talk to patients while you're there; ask how things are going. Consider how you feel while talking with the surgeon. Are you comfortable talking with this person? Are you getting candid answers to your questions?
Ask about computer imaging, about photographs of patients with features like yours. "You're always going to see the best, but some are honest enough to show you their '80%' pictures," says Powell. "Otherwise, there's an implied guarantee. Some even supply you with former patients to talk to. Even then, sometimes you get just the 'wow' patients."
10. Teen surgery. "Lots of kids feel shy, feel self-conscious about themselves," says Powell. "We have to be very careful. Once we talk to them, realize they're socially and emotionally stable -- and if they have a real problem, we will fix it. Sometimes fixing the nose or something that makes a teenager stand out can really help their self-image."
"Liposuction is a little bit iffy for teenagers," he says. "But we do a fair number of noses -- that's an obvious deformity and something that can be corrected at that age with very good results. Pinning ears back if they're very self-conscious can help. We can also correct acne scarring, once the acne process stops."
But parents should make sure there's a real good reason for the facial plastic surgery, says Powell. "If the teen wants to look like Britney Spears, that's one thing. We can't do that. It's important that a teen already has a good self-image, that they just need a little help with body image."