BY MARK ANDERSEN / Lincoln Journal Star
Plastic surgeons feel a bit nervous about a show they admit has mostly given them good exposure.
In one hour, under the magic of television, people like Candace Sturgeon of Lincoln, a former wallflower whose "Extreme Makeover" appeared Thursday on the ABC network, returned home after $60,000 in surgeries.
Now she is undeniably beautiful.
The show holds out hope for others who have walked through life perpetually unnoticed. But is it real hope?
The fallout from "Extreme Makeover" -- a program where a select few win cosmetic surgery, plus teeth repair, clothing and hair styling -- has been both positive and strange, said Julie Bantam, office manager of Plastic Surgical Arts in Lincoln.
The aesthetic surgical profession always has been misunderstood and this won't uncomplicate it.
People bring in photos saying, "I want to look like this," she said.
That can't really happen.
Other unrealistic expectations come from people who want to look good when they leave for their cruise next weekend. A facelift now could only make them look like they've had surgery.
The term "plastic" confuses people into thinking this surgery is somehow different from other surgeries, said Dr. Philip Metz, one of Lincoln's five cosmetic surgeons. Plastic comes from the Greek word plastikos, which means to mold or reshape. Surgeons trying new techniques on disfigured World War I soldiers hit upon the term at the same time chemists were developing moldable synthetics, he said.
Plastic surgery is surgery. Every operation has at its basis a surgical technique created to deal with a problem deformity, Metz said. Many were ugly wounds that left thousands of young war survivors living in closets.
People think they are new techniques, Metz said. Nose jobs and tummy tucks are more than a century old.
Sometimes only one breast develops in a woman. Over the years, wax, ivory and glass balls have been used to augment female breasts.
As surgeons became adept at restoring features, he said, they slowly adapted the techniques to improve the looks of people with normal features. This progression continues. The routine use of endoscopy in brow lifts, common now but rare a decade ago, evolved as a way of dealing with the massive facial fractures of accident victims, he said.
While the ravages of age aren't equal to those of war, the effects can be similar. Many women in their 50s always wear turtlenecks and scarves to hide their necks, Metz said.
It's not uncommon for people to question if their desire for something to make them look better betrays an inner weakness, Bantam said.
"God made plastic surgeons too," Bantam tells them. "It's your choice."
Chances are, however, the outcomes will be subtle.
A good result in cosmetic surgery is where friends ask: "Wow, where did you go on your vacation? I want to go there, too. You look so relaxed," she said.
Physicians screen carefully for prospective patients with realistic expectations.
People want plastic surgery to fix their marriage, Metz said.
What it can do, Metz said, is help the women who says her grandchildren think she's always mad at them because her face sags.
Much of the time, people around the patients don't even notice their problems.
"Plastic surgery doesn't change how people feel about you," said plastic surgeon Todd Orchard. "It may change how you feel about yourself."
That may be enough.
"If you can change the attitude," Orchard said, "You can change how the person looks."
For example, Metz said, women come in for breast reconstruction following cancer surgery "looking like whipped dogs, their tails between their legs. Six months later (after reconstruction) they come in fit to kill."
Nobody sees their missing breast but themselves and their husbands, he said.
"Especially in breast cancer," he said, "it's impossible to make a breast that matches perfectly."
And, yet, these women are happy with their reconstructions.
Everyone has subtle asymmetries, Metz said.
A composite facial image created from a mirror image of just half a face often looks nothing like the real person, Metz said.
Mirrors deceive in other ways.
"In a mirror we see what no one else sees," he said.
In a mirror, we see right eye to right eye. It's backwards. In photographs, we see right eye to left eye. While that's how others always see us, he said. It's also why nobody likes photographs of themselves.
Plastic surgeons not only have to know whether they can improve the looks of their patients but whether they can give the patient the look they want.
Metz uses the example of Michael Jackson's nose.
"I don't know of anybody who would set out to do that," Metz said. "It's an example of going too far. And now you can't get it back."
Jackson's first surgeries resulted in a nose that was perfect for a black woman, he said. He wasn't satisfied.
"Michael Jackson had a good result a couple of times but not to where he wanted to go."
According to some studies, up to 15 percent of people requesting plastic surgery suffer from body dysmorphic disorder, in which a person can never be satisfied with their looks. Operating on them can be a disaster.
Fortunately, Bantam said, those people generally reveal themselves by the way they talk about their bodies.
"We don't operate on everybody who comes to us who wants it," she said.
Most patients come in knowing what they want. Metz and Orchard are leery of the ones who come in seeking only physician input.
"A doctor can cripple somebody by saying: You have an ugly nose. I should fix it," Metz said. Up to then they may have been perfectly satisfied with their nose.
His typical response, Metz said: "You say you don't like this. I can see that." But there are borderline doctors who will take the money and run, he said.
Any physician can claim to do plastic surgery. Patients need to check credentials and references.
Physicians also look critically when a woman says her husband wants her to have this or that procedure.
"Normally in a relationship," Orchard said, "that person wants the other person to be happy.
"You don't do the operation for someone else," he said.
Drs. Metz and Orchard have other concerns with "Extreme Makeover."
They're doing an awful lot of surgery at one time, both said.
Medical data, Metz said, shows that long, 12-hour procedures have more frequent complications, such as higher infection rates, pneumonia and blood clots.
While it may make sense to do several things on a face all at one time, Metz said, it's better to do breasts and stomach liposuction in two shorter surgeries.
It's not just the danger from prolonged anesthesia, Orchard said, "It's hard to keep your mind active for 12 hours."
The procedures require small delicate movements.
Most surgeries are successful when the patient lives, Metz said. That's not true of cosmetic surgery, he said.
"You're at the 99.9 percent level of success," he said.
Three things can happen in any surgery. It can get better, stay the same or get worse. Only one of them is good with plastic surgery.
To do eight hours of procedure for the purpose of showing how long you can operate: "Been there, done that," Metz said.
Deaths occurring with liposuction, Orchard said, are usually those done in combination with work on the face.
Dr. Garth Fisher of Beverly Hills performed the 12-hour cosmetic surgery of Candace Sturgeon, the Lincoln woman who appeared on "Extreme Makeover."
Fisher said he learned his craft studying with some of the most respected physicians in the profession.
"They routinely did 10-12 hour cosmetic procedures," he said during a telephone interview.
Longer times under anesthesia are safe up to a point, he said, as long as it's a healthy patient.
"It's not something I would do on someone with high cholesterol," he said. "I'm not giving the message that a lot of surgeries is OK," he said.
"It has to be case-by-case basis." The patients for "Extreme Makeover" were carefully screened, he said. "Certainly, these people asked for even more," he said, "and I said, `No.'"
Overall, Fisher said of "Extreme Makeover," "It's a good show. I wish they'd talk more about risks of surgery."
One problem of the show is that it may lead to unrealistic expectations. In one hour on television, patients go from this to that, he said.
People don't understand, he said, that he has a great backdrop of people, dentists, wardrobe, trainers, and others that make him look a lot better than he is alone.