Want to resurface your skin or reshape your body? Here's your guide to today's cosmetic surgery options

Ever wondered

whether a nip and tuck could transform you? Many people have. Cosmetic procedures in North America increased by more than 300 per cent between 1997 and 2001, thanks to ageless celebrities and new techniques at affordable prices. Still, altering your appearance only goes, well, skin deep. “People know that renovating a kitchen isn’t going to save their marriages, and neither will renovating their bodies,” says Dr. Elizabeth Hall-Findlay, a plastic surgeon in Banff, Alta.

Considering cosmetic surgery? Make sure your expectations are realistic, talk to your doctor about risks and find an experienced technician. To help you, we got the goods on the most common procedures.

  For glowing blemish-free skin

Type of procedure How it works Recovery time The fine print
Vein injections, or sclerotherapy ($80 to $250) A solution injected into red broken blood vessels and varicose veins makes them collapse and disappear None Skin tone can darken or lighten in affected areas. Treatment won’t prevent other veins from surfacing
Chemical peels ($100 to $4,000, depending on strength) Acid solutions applied to the face remove sun spots, acne scars and other blemishes None for light peels; two weeks off work for strong peels (roughly equivalent to a surgical facelift) Light peels often require multiple sessions; strong peels carry risk of scarring, discoloration and infection
Microdermabrasion ($150 per session) Crystals slough off dead cells, acne scars and sun spots to reveal smoother skin and improve elasticity Virtually none, but skin may be slightly red and sun-sensitive Not recommended for sensitive skin. The glow lasts only two weeks, but skin will feel softer for four to six weeks
Non-invasive lasers ($200 to $500 per session) Lasers target and remove freckles, age spots and spider veins Treated spots will scab over and heal in one week Possibility of temporary bruising. More spots or veins may surface
The magic of Botox?
Meredith Birchall-Spencer gave Botox and microdermabrasion a shot and was impressed with the results. Botox smoothed out a deep furrow in her brow. But Birchall-Spencer, 33, had second thoughts about the procedure when she told her husband, who said, “I wondered why you had no expression on the top half of your face.” Microdermabrasion is another story: Birchall-Spencer compares it to a deep-cleansing facial and says it helps eliminate sun discoloration. “It’s expensive,” she admits, “and more clinical than a regular facial, so it’s not as relaxing.” Still, she books microdermabrasion twice a year.

  For younger-looking wrinkle-free skin

Type of procedure How it works Recovery time The fine print
Botox injections ($200 to $500) A protein made from botulism bacteria is injected directly into the facial muscles to relax them for several months None, but bruising and needle marks may be visible for a short time Avoid if you have a neuromuscular disorder. Also, poorly placed needles can cause eyelids to droop or interfere with smiling or speech for six months
Temporary fillers ($300 to $800) Synthetic and naturally derived fillers are injected into wrinkled areas or lips None, but minor bruising and swelling are common Collagen may provoke an allergic reaction, so a skin allergy test is a must. Results last three to six months
Longer-lasting fillers ($750) Injected synthetic fillers (such as Artecoll), made of plastic microspheres suspended in collagen, fill out wrinkles or lips Minor bruising and swelling Artecoll lasts five to 10 years (good if it’s the desired result; bad if it isn’t). These fillers can also bunch up or shift position and can only be removed surgically

  For sharper profiles

Type of procedure How it works Recovery time The fine print
Eyelid lifts, or blepharoplasty ($3,000 to $5,000) Excess skin and fat are cut away from the upper and/or lower lids and the area is tightened. Simpler and less painful than a facelift One to two weeks for swelling and discoloration to subside Vision is occasionally blurry during recovery. Results last five to 10 years. Provincial health insurance may cover some costs if sagging skin was obscuring peripheral vision
Nose job, or rhinoplasty ($3,000 to $5,500) The nose is downsized or reshaped and nasal breathing problems may be corrected Two weeks off work; more if bending or lifting is involved. Swelling can take up to one year to disappear completely Patients are most often dissatisfied with this type of surgery, so follow-up surgery is common. Provincial health insurance may cover breathing-related surgery
What cosmetic surgery won’t do

When you’re paying hundreds or even thousands of dollars for a cosmetic procedure, great expectations are the norm. But responsible doctors won’t operate on someone with unrealistic hopes. “Part of the consultation process involves the patient assessing me, but it’s also about me assessing them psychologically,” says Toronto dermatologist Fred Weksberg. “We can promise improvement, but we can’t promise happiness.”

Here are a few other things plastic surgery won’t deliver:

· It won’t make you look like Julia Roberts “Esthetic surgery isn’t an exact science, so there’s no guarantee of the results,” says Nancy Nielsen, president of Gray Communications, a marketing firm for esthetic practitioners. Your heredity and race will affect scarring, healing and outcome.
· It won’t transform your whole body TV programs that show women getting five surgical procedures at one time make doctors angry. “People come in wanting several surgeries at once and they don’t understand that it can be unsafe,” says Dr. Kimit Rai, a plastic surgeon in Vancouver.
· It won’t change your life “There’s an expectation in our culture that the better you look, the more access to love and happiness you’ll have,” says Virginia Blum, a University of Kentucky professor and author of Flesh Wounds: The Culture of Cosmetic Surgery (UC Press). But no surgery can provide that. Though Dr. Elizabeth Hall-Findlay, a plastic surgeon in Banff, Alta., has many happy patients, she also has some who are miserable about their altered appearance. “I’ve seen people who were convinced they couldn’t get a date because of some feature,” she says. “Surgery makes them feel worse because you’ve taken away their excuse.”

  For sleeker figures

Type of procedure How it works Recovery time The fine print
Breast reduction (often covered by health insurance, but some doctors charge additional fees from $1,500 to $4,000) An incision in the lower part of the breast removes excess tissue Two weeks off work; no exercise for at least six weeks Risk of scarring and loss of sensitivity. Repositioning the nipple may prevent breastfeeding
Liposuction, or lipoplasty ($1,000 to $1,500 per area) A long tube is inserted to vacuum out fat One to two weeks. A supersnug girdle promotes skin shrinkage and minimizes swelling and bruising Best for slim people with localized fat deposits such as love handles. Blood loss is a concern in liposuction involving more than five litres of fat, and a few people have died due to poor monitoring
Tummy tuck, or abdominoplasty ($3,500 to $8,000) Incisions between the navel and pubic area allow doctors to remove excess tissue to create a flatter-looking stomach One month (an abdominal binder is needed for two weeks); no exercise for four to six weeks Often mistaken for a weight-loss plan, this surgery only removes excess skin and fat. Scarring, lingering numbness and high risk of blood clots are concerns
Breast lift, or mastopexy ($4,000 to $7,000) Removing excess skin and repositioning the nipple can reverse the effects of gravity but won’t change cup size Two to three weeks The larger the breast, the bigger the scar. Repositioning the nipple may prevent breastfeeding
Breast augmentation ($4,000 to $9,000 per pair) Depending on their size, silicone or saline implants are inserted under breast tissue through the armpit, breast, areola or navel One to two weeks off work. Loss of ability to raise arms for three weeks; no exercise for one month Silicone implants don’t increase your risk of cancer, but all implants involve risk of infection, hardening, leaking or rupture. They can also complicate a mammogram. Follow-up surgery is common
The downside of surgery

Laura Lyford has hated her breasts since she was a teenager. At five foot two, she felt her double-Ds were an embarrassment: “They entered the room before I did.” So, Lyford had a breast reduction at age 40. She was elated at first but has since changed her perspective. “I look great with my clothes on, but I’m not so happy when my clothes are off,” she says. The reason? Scars run from under her arms to her cleavage and vertically up each breast to the nipple. “My husband says it doesn’t bother him, but it bothers me,” she says. Her left breast also became infected, and the nipple has never regained sensation. Lyford’s chronic backaches and headaches disappeared, but she says she still wouldn’t have had the surgery if she had known then what she knows now. “Whatever I thought it would do for me, it didn’t.”

10 questions to ask your doctor

Before you get a lift, laser or lipo, get informed. Canada doesn’t regulate who performs cosmetic surgery, so anyone holding an MD can practise—and being a doctor doesn’t immediately confer expertise. Although initial consultations range from $50 to $150, it’s worth shopping around. Here’s what you need to ask, according to our experts:

  1. What is your medical specialty, what training have you had and what percentage of your practice is devoted to cosmetic surgery? (You should avoid someone whose only training is a two-day resort course or who only performs a couple of surgeries a year.)
  2. How much experience do you have in this specific surgery, and how many times did you perform it last year? (Skill in Botox injections does not guarantee a talent for tummy tucks.)
  3. Do you have hospital privileges? (This is important to keep in mind if you’re considering a riskier surgery such as liposuction.)
  4. Can you show me before-and-after photos of your recent patients, and can I talk to some of them? (Don’t settle for seeing a photo image of your face on a computer.)
  5. Can you describe what will happen before, during and after the surgery?
  6. What are the possible complications, and how often have you seen them happen? (Don’t sign a medical waiver that you don’t understand)
  7. What would I need to do to prepare for surgery, and are there any lifestyle changes I need to make? (You may need to quit smoking or lose weight for best results.)
  8. Is the result I want realistic? (This is a key point you need to agree on.)
  9. What happens if the results aren’t what we agreed on? Will follow-up procedures cost more?
  10. What is the total cost of the procedure, and will provincial health insurance pay for any medical component of it?