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Author's Introduction

Much of what's written about cosmetic surgery in newspapers and magazines, and even in some medical journals, is half-truth, myth, or advertising. The media has distorted public perception with overly negative or sensationalized stories, and medical specialty organizations contribute to the mayhem by promoting warring viewpoints to establish their own market share. The misinformation is further compounded by the rapid pace of technological change. As soon as we begin to understand one procedure, new ones pop up, and the confusion begins anew. Many of today's finest techniques didn't even exist five years ago. And five years from now, these may be ancient history. For example, the very latest developments involve non-surgical, noninvasive therapies, including laser treatments, light treatments, radiofrequency treatments and mesotherapy (superficial injection therapy). These treatments can help you maintain what you get after surgery. But better yet, for the right patient, they can completely replace surgery and get you looking great. There's little or no recovery time, little discomfort and the risks are almost zero.

Moreover, I feel a patient's psychological perspective is often ignored, and this, in many ways, is the most important aspect of the whole process. That's why I've chosen to open the book with a chapter called "The Psychology of Cosmetic Surgery." Motivation, media influence, culture, expectations, family pressures, and other factors have an enormous influence on one's perceptions and decisions.

On the physical side, cosmetic surgery is safer than it's ever been, thanks to innovations in anesthesia and other techniques. A new kind of numbing medicine known as "tumescent anesthesia" was introduced about 1990 and is now the standard. General anesthesia, which involves heavier drugs, intensive (and expensive) medical supervision, a sometimes more difficult recovery, along with significant risks, is typically unnecessary for the physicians who are trained to use the newer local anesthetic/light sedation combinations. With these anesthesia techniques, side effects such as nausea, drugged feelings, and a lengthy postoperative recovery, can usually be avoided. But the best news is that your surgery can now be done in an outpatient surgical center, and you will be able to go home only a few hours later with a new body.

Having one of these procedures performed under local anesthetic also gives you the option of observing what's going on in the room. It's like watching a chef in the kitchen or an artist in the studio while he works - on you. You are awake and aware, but feeling little or no discomfort. You may also be able to speak with the doctor and the assistants, and that kind of communication can actually make it a very positive experience. Or, as is frequently done, you can elect to have a light sedative given intravenously during the procedure, so you are unlikely to remember a thing. If you prefer, you may elect to have an anesthesiologist. In that case, we encourage the anesthesiologist to limit the amount and type of medication given, in order to limit anesthetic risks, and side effects such as nausea and vomiting.

In this book you'll read detailed descriptions of what to expect from a variety of procedures, including specifics on how each procedure is done, what drugs are used, how you'll feel, and what the recovery will be like. You must be aware, however, that no surgery is ever totally risk free. If you are planning to have cosmetic surgery, you must read chapter 14 on complications, and carefully examine the detailed complications section on the home page of our website, These are blunt and realistic assessments of the potential for problems after surgery. If you don't fully understand this information, you should go no further until you have discussed it with your surgeon.

I've also included a chapter on choosing a cosmetic surgeon, with specific, honest information. Choosing a physician can be a stressful experience because, frankly, doctors can be intimidating. They speak a different language, and they seem to live in a different world. They know things that most people don't know, and sometimes they wield a lot of power. Some of them are wealthy or famous. Many have not had enough experience in the exact surgery you're inquiring about, and some won't take the time to answer all your questions. So how can you tell which doctors are skilled, experienced and caring, and which are not? I'll give you some guidelines that can be useful for the rest of your life, beyond your cosmetic surgery experience. Information specific to my practice can be found in Appendix B and on my website,

Finally, it's important that you know that I've been a cosmetic surgery patient myself. In 1992 I had abdominal liposuction, and in 1995 I had a second liposuction to "fine tune" my result. I've also had a deep facial acid peel to reduce the appearance of some acne scars. This was done in the days before laser was used, when the procedure was called a "chemical peel." I believe I have a unique perspective which helps me to see my patients' points of view. I'm aware of what they're feeling. I understand their apprehensions, their physical responses, and their expectations. I'm writing from the empathetic yet realistic viewpoint of a physician, with the added understanding of someone who has also been a patient.

You can also review my personal and professional background, curriculum vitae, and articles I have published in medical journals. These are all available at

This is a complicated field. There's been an explosion of interest, and at the same time, continuous revolutions in the technology. My hope is that you will find enough clarity here to answer your questions. As a cosmetic physician, my goal is to help you look and feel your best.

Robert A. Yoho, M.D.

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