Demand for plastic surgery grows annually

Andrea Barthelemy, Deutsche Presse-Agentur, Hamburg, Germany

A nose-job for your 18th birthday or a larger bosom as reward for a high-school diploma -- the craving for a perfect appearance has not yet reached these extremes in Germany -- unlike the United States.

Nonetheless, the number of cosmetic operations continues to grow by about 10 to 15 percent annually, according to experts.

"Plastic surgery is the only specialized field that is still expanding in a dwindling health market," said Professor Wolfgang Muehlbauer, president of the Association of German Aesthetic Plastic Surgeons.

Detlef Witzel, plastic surgeon, agreed with Muehlbauer: "The general economic situation does not have any effect on us. Although the number of surgeons is increasing, we cannot fulfill the demand by any means."

Most popular among the female patients seeking the services of plastic surgeons are liposuction treatments, breast sculpting, smoothing eyelids and ears, nose restructuring, face lifts and tummy tucks.

According to an estimate for last year, the association's 800 members alone performed about 350,000 operations on 87,000 female patients. But the true number of people who submit themselves to the plastic surgeon's scalpel or other cosmetic corrections is not known. Some estimates speak of 400,000 patients and 800,000 operations.

Women from the middle and upper classes create most of the demand, but increasingly, the patients are men who want to make themselves more attractive.

"The demand from men is growing but not as strong as public opinion would have it. They have a share of about 12 percent," said Marita Eisenmann-Klein from the Union of German Plastic Surgeons.

Men have other priorities. Nose jobs are top of the list followed by removal of bags around the eyes and drooping eyelids. Tummy tucks and removing of excess fat rolls around the waist also are, Witzel said.

Apart from the fact that such operations have to be paid out of patient pockets, and therefore are not tabulated as carefully as other operations, there is another reason for the disparate estimates. The title "plastic surgeon" is not legally protected in Germany.

Any specialist -- gynecologist, dentist or dermatologist -- may perform plastic surgery. Although they are not allowed call themselves "plastic surgeons", a label such as "cosmetic operations" is permissible on visiting cards.

"Charlatans," says Muehlbauer about the growing number of colleagues trying to acquire "special skills" of a plastic surgeon in crash courses. The offerings include weekend courses where liposuction is practiced on pig heads.

Plastic surgeons, on the other hand, have to complete a six- year specialty course of study.

For years, plastic surgeons have been lobbying for quality controls and stricter regulations for their discipline. However, the lobby of established specialists has proved too strong.

In keeping with vague statistics, the number of failed operations, errors or compensation claims in response to the aforementioned problems is unknown. Some so-called beauty specialists would rather pay a patient hush-money rather than ruin their reputations.

On the other hand, the medical possibilities are continually expanding. They are becoming less complex thanks to micro invasive operations.

The array of tools and compounds available to a plastic surgeon has grown dramatically in recent years.

There are at least three dozen different kinds of substances to smooth wrinkles apart from the toxin botox, which affects nerves. The substance paralyses parts of the facial muscles to dispose of wrinkles.

Laser procedures to remove skin spots and directed light to smooth skin are continually being improved.

Breast enlargement is another area where things are changing. After years of criticism, silicon implants are re-emerging. The cushions no longer consist of fluid silicon that may leak, but rather are made of silicon sponges.

As in the U.S., the trend toward breast enlargement has begun to overtake breast reduction, which formerly often was recommended by surgeons on medical and orthopedic grounds.

The plastic surgeons' society estimates the number of breast enlargements now is substantially more than the number of reductions. About half the breast operations being performed are to enlarge, an increase from roughly one-third in years past.