Your neighbour's looking refreshed and younger after an overseas trip. Your colleague appears different, but you're not quite sure what's changed. Maybe they've had a nip, tuck or injection. Bay of Plenty Times Weekend reporter Dawn Picken examines celebrity trends driving plastic surgery and talks to locals who've gone under the knife
From Self-Conscious to Satisfied
Amy* wasn't self-conscious about her profile until her 20s.
"Big noses are on one side of the family, and it only takes a couple of comments … to give you a bit of a complex."
The Papamoa mum was living in Taranaki back then and found her surgeon online.
"He looked to be very reputable and professional, and I met with him in his rooms in New Plymouth."
Amy had her nose job in Auckland 11 years ago, at age 29. "I'd thought long and hard and saved up."
She laid low for a month after surgery. "It looked like I'd been severely beaten up. The swelling can take a year to come down."
The surgeon shaved the bridge of her nose but didn't change its shape. Surgeons say dorsal hump reductions are one of the most common rhinoplasty procedures, done to change what mum and dad gave you, or to fix a formerly broken nose.
Cosmetic surgery cost Amy $9000 or $10,000.
"I'm rapt that I did it. It's not something I regret. My mum, the nose came from her side of the family, and she said, 'Oh great, good on you. I wish I'd had the money to get it done myself'."
She says people have since commented she seems more confident, and when she married several years post-surgery … "I could be photographed on any angle and not have to worry."
Still, Amy doesn't want to disclose her identity because many of her friends and family members don't know she's had work.
"Some people could think you're vain for getting it done. Which for me, I don't feel it was a vain thing. I felt it was affecting my confidence. A lot of people haven't noticed. You think that people will, and they haven't."
Celebrities and Trends
Amy says she has no desire for other popular procedures like breast augmentation. But increasing numbers of women and men are supporting a multibillion-dollar worldwide industry. Some are going under knife or needle to emulate celebrities like the Kardashian clan, whose members sport pouty lips, plump bums and equate plastic surgery to makeup. TV programmes such as Bravo's Botched further reinforce the notion everyone's been nipped, filled or tucked.
It's unclear from querying the national plastic surgeon association and the NZ Medical Council whether the country has readily available data on which procedures are most popular and how many are performed.
Most cosmetic surgeries are privately funded, and a Ministry of Health spokesman says the department doesn't collect data on cosmetic procedures performed by GPs.
Plastic surgery trends emerge in a report from the American Society for Aesthetic Plastic Surgery. The organisation's most recent survey of data from 2017 was published earlier this year.
It reported increases in the following procedures: eyelid surgery, up 26.3 per cent; buttock augmentation, 25.5 per cent; fat transfer to the face, 22.3 per cent; facelifts, 22 per cent; and neck and upper arm lifts, 20.1 per cent.
Top five surgical procedures for women, according to the survey, were breast augmentation, liposuction, breast lift, tummy tuck and eyelid surgery. Top five nonsurgical procedures were botulinum toxin; hyaluronic acid; hair removal; nonsurgical fat reduction and chemical peels.
The 16th most popular procedure was labiaplasty, where a surgeon removes excess tissue from the labia, part of the female genitalia. The procedure has increased about 217 per cent the past five years but saw an overall decrease in number of procedures performed in 2017 of 10.7 per cent.
"It remains to be seen if this particular procedure is a passing trend or a permanent one," says the report.
Top five surgical procedures for men were liposuction; eyelift surgery; breast reduction; tummy tuck and facelift. Top non-surgical procedures were botulinum toxin; hyaluronic acid; nonsurgical fat reduction; hair removal and photo rejuvenation (IPL).
Surgical procedures were up 11 per cent in the US in 2017; nonsurgical procedures rose 4.2 per cent.
Two Tauranga surgeons declined to talk to the Bay of Plenty Times Weekend for this story. The office manager at the practice said their policy was not to talk to journalists.
Another plastic surgeon operating from Grace Hospital declined to comment, saying he was the wrong doctor to speak with because his "philosophy in plastic surgery was steeped in the hundreds of years of plastic surgery history, where the origins of restorative surgery are based on war surgery".
The manager of a Hamilton practice said the surgeon was too busy this week to comment; representatives of three Auckland-based plastic surgery offices didn't return messages.
The sole Tauranga plastic surgeon who agreed to answer our questions was Dr Tristan de Chalain. He says his most popular procedures are Botox ™ and fillers, liposuction, breast augmentation, eyelid tucks and labiaplasty.
New Zealand Association of Plastic Surgeons vice-president John Kenealy heads the plastic surgery department at Auckland's Middlemore Hospital. Kenealy says breast augmentations and tummy tucks are still popular.
"Women who've had children and then feel they've given so much to their children and want to get their old body back, abdominoplasty can really help with that."
Kenealy says cosmetic surgery is becoming a little more common for men.
"As men are more aware they're allowed to have an opinion about how they look, they're more conscious about coming forward and recognising things can be done."
De Chalain says men make up about 15-20 per cent of the patient population in plastic surgery offices.
"Most are there for skin cancers, but in terms of aesthetics, the most popular calls are for gynecomastia [man boobs] in the younger group, and eyelid tucks and facelifts in the older group."
Kenealy says while bringing your surgeon a photo can be helpful for women considering breast augmentation, some aspirations are impractical.
"Celebrities who are greatly enhanced, it's not a healthy way to be. A mainstream plastic surgeon would try to steer the patient towards a more realistic goal."
De Chalain agrees expectations must be realistic. "I once had a Japanese lady who wanted to look like Audrey Hepburn."
He still sees prospective clients waving celebrity photos asking for a "nose like hers," or "lips like these".
What about surgically packing more junk in the trunk, as some actors and pop stars have done? Kenealy says bum lifts and enhancements aren't nearly as common as other surgeries. He suggests talking to a family doctor or plastic surgeon for a referral to someone who performs high volumes of posterior procedures.
"You need someone who's a bit of a specialist in that area."
Mount Maunganui-based nurse specialist Leanne Cashmore injects botulinum toxin (brand name Botox) and fillers. Cashmore has been practising appearance medicine 20 years and sees big differences between what's popular here and what's trending overseas. Take lip fillers, for example.
"In Sydney, the bigger the better. In Brazil, the bigger the better. We're very conservative in New Zealand, but they want to look done overseas."
Travel consultant Jackie Brown takes around 50 people (nearly all women) four or five times per year to Thailand with her business, Bums, Tums and Gums.
When I reach Brown, she's driving from Papamoa, where she'd just seen two clients who want tummy tucks. The Omokoroa resident says the procedure costs $6500-$7500 in Thailand. A Tauranga plastic surgery practice website lists full abdominoplasty at $19,000 to $23,500.
Brown says a facelift plus upper and lower eye lifts in Thailand is priced around $8500, while her clients have had domestic facelift quotes ranging from $24,000 to $32,000.
Brown visits the same hospital in Pattaya each time and says she deals with the same five surgeons, all board-certified in Thailand. Some have international qualifications, too.
"The hospital is about the same size as Tauranga's. It's a big working hospital with maternity and everything …"
Brown says an employee of the Bay of Plenty District Health Board came on her last trip for surgery and remarked how advanced the facility was.
"I've been going for six years to that hospital and they've never changed staff. Their retention rate is really good."
Client Cheryle (who didn't want her last name used) travelled with Brown to Thailand two years ago. The 57-year-old Otumoetai business owner says getting cosmetic surgery is "… the best thing I've ever done for myself, and if you ask me, I would do it again".
Cheryle had multiple procedures – dental work, removal of a double chin, breast lift and tummy tuck.
"Not only did it improve my appearance, it improved my mind and my life and my thinking in general," Cheryle says parenting a special needs child caused her to neglect herself for years.
The Thailand trip changed that. She was initially refused the operations because a routine medical work-up revealed she had dangerously high blood pressure. Thai doctors put her on medications that brought her numbers to normal. Surgeons operated 10 days later.
"That told me they were looking after me. They weren't in a hurry to get me on the table and take my money."
She says healing went well, she had no complications, and is thrilled with her results.
"I went to have my mammogram and she [the technologist] said, 'Oh, who did that? You should be so pleased. I've seen so many [breasts] and they've done a fabulous job'."
Plastic surgeon John Kenealy says he has noticed more patients are having breast augmentations abroad.
"Naturally, we want to make sure people feel informed before they go overseas so they know what they're going to get."
He says Middlemore Hospital has handled eight cases of complications following cosmetic surgeries abroad since March. Some situations were straightforward, but others required multiple corrective procedures.
"I'm certain that's more frequent from having had surgery overseas, rather than having it here."
The New Zealand Association of Plastic Surgeons repeated its warning to Kiwis thinking of travelling for cosmetic surgery following the death of a Melbourne man after a cut-price operation in Malaysia. Kenealy told the New Zealand Herald in December 2017 plastic surgeons in some countries may not be trained surgeons or even trained doctors.
"Commonly performed cosmetic surgery procedures, such as body liposuction, tummy tuck and breast surgery are major operations that carry a risk of blood clots, which can be life-threatening. Long haul travel one month before or after surgery further increases that risk."
On the other hand, he says people having surgery in New Zealand can be in an accredited hospital with highly-trained professionals. Any complications can be managed close to home.
Who's a Plastic Surgeon?
All plastic surgeons in New Zealand are members of the Royal Australasian College of Surgeons. The NZ Association of Plastic Surgeons looks after plastic surgery specifically. However, Kenealy says general practitioners may perform cosmetic procedures.
"Eyelids are an area some GPs will do surgery on … sometimes they'll market themselves as having plastic surgery experience, but that can be a weekend course rather than a five-year training programme, so that's one of the challenges we face in New Zealand and they also face it overseas."
He cites cases in Australia where patients who had breast augmentations with GPs suffered serious complications. One woman died in Sydney last September after a botched breast procedure. The New South Wales Health Care Complaints Commission is conducting an inquiry into cosmetic health service complaints throughout the state.
Kenealy says, "We're lucky in New Zealand that doesn't happen so much. It could happen. There's always that potential."
He says the term 'plastic surgery' is overused, partly because he and his colleagues are prominent in hospitals.
"We might have junior doctors come through plastic surgery and they sort of suggest they've been trained in plastic surgery, whereas they might have just spent a few weeks with us.
"The actual term plastic surgeon is not patented, there's no rules specifically legally about its use so it does get overused by people who aren't necessarily truly plastic and reconstructive surgeons as defined by the Medical Council of New Zealand."
He suggests anyone who wants to check out a doctor visit the association website, www.plasticsurgery.org.nz, email email@example.com or visit the Medical Council: www.mcnz.org.nz. Kenealy thinks most consumers aren't swayed by flashy websites and pervasive ad campaigns.
"My personal experience is word-of-mouth is still very powerful."
Not Child's Play
Surgeries for children with congenital abnormalities such as cleft palate are often funded under the public system. Kenealy says in other instances, such as a teenager with dramatically asymmetrical breasts, public funding may also be available.
De Chalain says he wouldn't consider performing breast augmentation on a patient under age 18 and would hold off on rhinoplasty until at least 16 years of age.
Nurse specialist Cashmore says she won't inject minors, and would be wary of treating an 18-year-old.
"If they think they've got creases at that age, I think something's wrong psychologically. You've got to really evaluate a client before you go ahead and start treating them."
One common procedure among children is otoplasty, or cosmetic ear surgery. An Auckland plastic surgery website states, "New Zealand insurance companies do not cover congenital conditions or cosmetic procedures; public hospital treatment is free, though wait times may be extensive."
De Chalain performs prominent ear correction from about age 4 or 5.
Bay resident Emma* says her family spent around $6500 to have her 13-year-old son's ears pinned.
"It was probably a natural thing for us because my husband had his ears pinned back."
Her son was being teased and she wanted him to start college without being self-conscious. The operation happened at a private hospital. Post-op photos of Richie* show an ear similar to the cauliflower profusion of All Blacks players.
Emma says that was expected. What was not expected was a haematoma – solid swelling of clotted blood within the tissues. She says her surgeon drained the ear.
Overall, healing has been longer and more traumatic than she'd imagined.
"I thought the bandages would come off and there would be these nice little ears, but the bandages came off and they were these monstrosities. They were really swollen."
Emma says she's seen a huge improvement from December to February, but was told Richie could see swelling for another year and sensitivity for up to three years.
Word-of-mouth led Emma to the surgeon. She knew another mum whose son had the same operation.
When it Goes Wrong
Maria* had breast reconstruction with a New Zealand-based general surgeon following a double mastectomy. She says her surgeon insisted on giving her 'D' cup-sized implants, though she'd asked for a 'C.' The skin on her chest was expanded over time and the surgeon inserted saline implants.
"They're not like a beautiful breast shape - they're simply bumps. They look like two big bottoms on my chest."
Six months later, Maria says she felt a sharp pain and found one implant had slipped beneath her armpit.
"They told me the implant had ruptured and was hanging in the silicon bag."
Maria's surgery was publicly-funded. She consulted a plastic surgeon, who told her he couldn't operate because he suspected cancer had returned. It had, and now Maria says she's stuck with two ruptured implants.
"I think going to a plastic surgeon, if it meant I was going to end up with an implant that was going to look like a breast … I would've wanted the reality of a breast if I had the money."
Plastic surgeon Kenealy of Auckland says many general surgeons successfully insert implants, "… and that's all they do, but something more complicated requires a referral to a plastic surgeon".
He says costs for private reconstruction of both breasts in New Zealand range from $20,000 to $80,000. The high-end surgery involves microvascular reconstruction using a patient's own tissue.
Fill, Snip, Tuck…or Nothing?
Some people choose to 'fix' body parts that have stunted self-esteem. Others do it to reduce pain. Reasons for altering appearance are complex – influenced by factors such as parents, peers and popular culture.
Amy, who had her nose job more than a decade ago, says cosmetic surgery is a very individual decision.
"I think if someone is feeling a lack of self-esteem and it is affecting their day-to-day life, by all means, go for it if it will make you feel better."
*Names changed to protect privacy
New Appearance Medicine Clinic in Papamoa
Angela Paton this weekend opens her first clinic inside a massage studio on Parton Rd. The registered nurse of 14 years says she has always worked in women's health and as she got older, became more interested in appearance medicine. She took a course in Auckland and has been practising injecting other nurses, friends and colleagues.
"Slow beginnings, but hopefully, word-of-mouth will spur things on a bit."
Injectors in New Zealand must be registered nurses or doctors. Paton says the doctor overseeing her work prescribes the Botulinum toxin and dermal fillers she uses.
Paton says wrinkle relaxers have become much more acceptable the past several years.
"Gone are the days where it was a real niche thing and people were worried about looking plastic. The emphasis is on working with women's natural beauty and increasing women's confidence."
*On Facebook as Appearance Solutions
Complaints and Inquiries
Patients can file a complaint against a practitioner with the NZ Health and Disability Commissioner: www.hdc.org.nz
To look up a doctor's credentials, visit: http://plasticsurgery.org.nz/ and