Plastic surgery seems to be the medical specialty of the "quick fix." A glance through the yellow pages under the subheading of plastic surgery in any metropolitan area is replete with advertisements listing the surgical services we provide. Although reconstructive procedures are usually mentioned in small type near the bottom of the advertisement, cosmetic procedures get top billing, often bolded and bulleted for emphasis. Whether it is the effects of aging or less than aesthetically pleasing genetics, our surgical services offer safe and effective solutions with short recovery times, and always, personalized care.

Do your eyes seem tired and droopy? Blepharoplasty can give you back your bright-eyed look. Is your figure a bit too boyish? An augmentation mammoplasty will undoubtedly enhance your femininity. Saddlebags detracting from the sleek lines of your spandex capri pants? Liposuction can smooth out those dimpled bulges. If you don't buy into the sentiment that wrinkles are mementos of smiles you have had, not to worry. Wrinkles can be burned, sanded, scraped, peeled away, or filled in, followed by temporary pharmaceutical paralysis of those pesky facial muscles that caused them in the first place.

Although this is an admittedly tongue-in-cheek review of both the invasive and minimally invasive procedures that fill our directory listings and our workdays, the core issues of body image and self-esteem are indeed serious. In a society that places an extremely high value on youth and fitness, it is at best ironic that we are in reality an aging and an increasingly obese society.

As clinicians, we have become quite adept at addressing the outward effects of aging; however, for some reason, our attention to obesity, until recently, has lagged behind, or as one of our authors noted, "The last politically correct prejudice seems to be against obese people." Let's be honest. Whom do we hire as our "front office" receptionists? More often than not they are women who reflect our "after" photographs and an unwritten but often-practiced job description would include "must have outgoing personality, but plus sizes need not apply." In reality, the larger our body mass, the more invisible we seem to become.

Certainly, obese individuals are visible to industry and commerce. This "growing" population is also deluged with a dizzying array of guaranteed quick fixes targeted specifically to their needs. A smorgasbord of options exists, including Atkins, South Beach, Weight Watchers, Lean Cuisine, Dr. Phil's rapid start, grocery store shelves filled with low-carbohydrate options (and higher prices) and strip malls promising Curves. Although the safety of these quick fixes is rarely questioned, the long-term effectiveness is, at best, undocumented. The Centers for Disease Control and Prevention (CDC) reports that currently more than 44 million Americans are considered to be obese (CDC, 2004). These data reflect an increase of 74% percent since 1991. So much for quick fixes.

Until research provides better clues to the etiology of this disease process and then better solutions aimed at prevention, bariatric surgery offers help, with clinically proven positive outcomes in sustained weight loss and for the complications associated with obesity, including adult-onset diabetes, hypertension, and cardiovascular disease. As with any major surgical intervention, there are serious risk-benefit issues to consider, and a multidisciplinary team of caregivers is critical. Plastic surgery nurses have a role in this team approach, as described in the pages that follow.

We are proud to feature four first-time authors in this issue. They are experienced professionals who are willing to share their expertise with us. We are also pleased to be able to reprint an article by a professional journalist who spent a successful career commenting on the world around her and then had the courage to look in the mirror and comment on her own reflection, giving a voice to 44 million people.

Although we tend to relegate our reconstructive services to the bottom of our advertisements and for simplicity have dropped reconstruction from our organizational identity, plastic surgery nurses are at their best as part of a multidisciplinary healthcare team. Bariatric surgery and improving the quality of life for the morbidly obese offer us yet another opportunity to do what we do best, but first, we need to walk for a while in their shoes.

Jeanne Prin Wyatt, RN, CPSN

Editor

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