Plastic surgery gets lift


In Los Angeles, facelifts, breast augmentations, tummy tucks and nose jobs are about as common as juice bars and bad traffic on the 405. 

While Los Angeles and the United States in general are known as a hotbed of cosmetic surgery, things aren’t so different in Israel. In fact, the Holy Land was host to an international conference on the topic this past March.

The four-day symposium, called “Plastic Surgery at the Red Sea,” was held in Eilat and focused on aesthetic and reconstructive surgery. The topics discussed included “fat grafting for aesthetic and reconstructive cases, aesthetic and reconstructive breast surgery, problem cases in rhinoplasty [nose reshaping], post-bariatric surgery and body contouring,” according to Dr. Amos Leviav, chairman of the Israel Society of Plastic and Aesthetic Surgery and head of the department of plastic surgery at Kaplan Medical Center in Rehovot.

The keynote lecture, given by Dr. Rod J. Rohrich of Dallas, offered a look further into the future. 

“He pointed out that the future of the specialty is related to the development of the field of stem-cell therapy, a technique based in the collection of cells and tissues of the patient, their cultivation in-vitro and their reinsertion in the damaged area of the [patient’s] body,” Dr. Marcos Harel, plastic surgeon and national secretary of the International Society of Aesthetic Plastic Surgery for Israel, wrote the Journal in an e-mail. “This will replace all the artificial devices used today like silicone implants.”

While there is no data on the subject, Harel wrote that the most popular plastic surgery procedures in Israel are breast augmentations, rhinoplasties, liposuction, eyelid surgeries and facelifts. This exactly mirrors the favorite choices of Americans,  according to a 2012 report by the American Society of Plastic Surgeons (ASPS).

Leviav pointed out in an e-mail that there are most likely similarities between the two countries because Dr. Leo Bornstein, an American, founded the first plastic surgery department in Israel, and many Israeli plastic surgeons are trained in America.

Although Americans and Israelis desire the same surgeries, there are some differences.

“In the U.S., women seeking breast augmentations ask for bigger sizes than Israelis,” Harel wrote. “In Israel, the average patient asks for a normal and ‘not surgical’ looking nose, while in the U.S. there is a large amount of such patients that ask for a ‘cute and small nose.’ ”

Here in the United States, the popularity of cosmetic procedures continues despite recent rough economic times. Last year, the ASPS report reveals, more than 14.5 million people underwent a procedure of some kind, including Botox. And while surgical procedures were down 16 percent since 2000, overall (including minimally invasive procedures), business was booming — up 98 percent during the same period.

Botox was by far the most popular non-surgical procedure,  with 6.1 million patients choosing it. Since 2000, the two biggest increases were in upper-arm lifts (skyrocketing 4,473 percent, from 338 in 2000 to 15,457 last year) and lower-body lifts (up 3,360 percent from a mere 207 to 7,163). 

Dr. Michael Salzhauer, who practices in Miami, attributed the explosion in arm and lower-body lifts to the obesity problem in America. 

“As the population has gotten fatter and fatter, more people have turned to gastric bypass and plastic surgery,” he said. “When you lose more than 60 pounds, you have a lot of extra skin. Nobody likes extra skin, especially in the arms. Because there are so many more people that have lost weight, they need those operations more and more.”

Salzhauer said he believes that facelifts are popular because of the baby boomer population. But Dr. Jason Diamond said that where he practices, in Beverly Hills, many of the facelift patients are in their 40s. The average age of his patients, he said, is going down. 

“They say, ‘Why wait till I’m 55 if I don’t like my neck now at 45? Why don’t I enjoy the next 10 years?’ People think that way now, and they know with the right doctor they will get the exact results they want.”

The Botox industry is booming, said Diamond, because it costs a patient $300 to $2,500, as opposed to $8,000 to $10,000 for a facelift. It is also preventative and used to treat migraines. 

Dr. Al Aly, a member of the ASPS at the University of California, Irvine, said Botox is popular due to the lack of risk it presents. 

“There’s a huge psychological push these days to accomplish things through non-surgical means. It is very effective with very low risk.”

In terms of his female Jewish patients, Salzhauer said that they go for mommy makeovers, which include breast lifts and tummy tucks after they’ve had children. Diamond said he sees a lot of Jewish girls just graduating high school who come in for a nose job, which can run $20,000. 

Plastic surgery, no matter what the procedure, will remain a lucrative and thriving industry because, Diamond said, it can improve one’s life and status. 

“It’s very important for people for their jobs and social lives. It’s a competitive world and people understand how important it is to look good.”

But what procedures are en vogue depends on time and place — whether it’s Hollywood, Haifa or somewhere else — and reflects different societies’ standards of beauty, according to Leviav. 

“The way we and society sees us, whether we are handsome and beautiful, is a question of education and culture,” he wrote. “In the extreme, a short fat green woman with sharp yellow teeth and red eyes may look a monster to us, but is Miss Universe of her world on Vega. In some African tribes, a lady weighing less than 250 pounds will not find a husband. Culture definitely influences how we want to look.”

Ages Up, Numbers Down at Heritage Pointe


Sam Schlesinger, 98, downloads The Jerusalem Post’s online
edition every day and distributes it to other residents of Mission Viejo’s Heritage Pointe. Vera Rabina, 63,
is the community’s youngest resident and a political asylum seeker from the
former Soviet Union. Her daily routine is to board a city bus or walk to a
nearby junior college, where she is enrolled in English-language classes.

   For six years, Evelyne Fidler, 87, also lived in the
community, enriched by the socialization of new-found friends. Rabbis came to
rely on Fidler’s adult grandson, Steve Sachse, to hoist the Torah and carry it
through the in-house synagogue during holidays.

Now, Fidler is befuddled by dementia, unable to use a spoon,
recall a friend’s last name or, as importantly, respond appropriately to a
potential emergency. Her need for 24-hour care outstrips the facility’s
licensed services. By mutual agreement, Sachse last month relocated his
grandmother to a non-Jewish board-and-care facility, licensed for Alzheimer
patients.

The 169 residents of Orange County’s only Jewish retirement
home possess a varying range of physical and mental limitations. Yet, compared
to the original occupants who moved in 12 years ago, new arrivals to Heritage
Pointe are considerably older and more frail. The average age is 89.

That demographic shift is changing expectations about
Heritage Pointe’s targeted population, which is less independent than
anticipated. Older residents are also likely to spur in the near future a
broadening of services, such as a contemplated dementia unit. Yet, despite an
over-60 county population of 13 percent that far exceeds the 4 percent state
average, there is no waiting list for Heritage Pointe’s 178 units, which
average $2,600 monthly. Occupancy has declined to 88 percent, which
administrators blame on a proliferation of newer, rival facilities that make
the county one of the nation’s most densely populated for senior housing.

The trends are presenting new challenges for the nonprofit
facility, its community-based leadership and their pledge to subsidize 20
percent of the population. Last year, Heritage Pointe supporters raised
$800,000 to underwrite in varying degrees 33 residents, contributing 7 percent
toward the facility’s $11 million annual operating costs. Private-paying
residents make up the rest. There is no government reimbursement or United Way
funding.

“If we had nothing but very old people with no money, it’s
not sustainable,” said Fred Forster, of Newport Beach, the volunteer president
of Heritage Pointe’s board. “We’ve got to have a mix. We don’t want broader
financial challenges.”

The most successful senior housing model, he said, is
assisted-living, where residents receive help for personal needs such as
dressing or showering. Other more established Jewish homes, such as Reseda’s
Los Angeles Jewish Home for the Aging and Encinitas’ Seacrest Village, offer a
broader care continuum, including 24-hour nursing. “We’re the new kid on the
block,” he said.

The advancing age of a still-healthy elderly population is
an issue throughout the nation, said Nancy D. Zionts, who specializes in aging
issues at the Pittsburgh-based Jewish Healthcare Foundation. The elevated
personal needs of older residents are forcing providers to redefine services,
edging closer to the environment of skilled-nursing homes, where residents
share rooms, but lack kitchens and patios.

“Five years ago, we couldn’t accept anyone who was
incontinent,” said Renata R. Loveless, Heritage Pointe’s administrator. “What
they thought assisted-living was going to be, isn’t so.”

Two-thirds of Heritage Pointe residents live independently,
filling their days with activities ranging from lectures to movies, cards and
services by itinerant rabbis. They rely on the 110-person staff only for
housekeeping, food service and bus service. About 74 residents require varying
amounts of fee-based personal services. Six are Holocaust survivors. There is a
contingent from New York and Florida, who moved to be closer to children, and a
group of former residents of Leisure World, a local retirement community.

While many older people resist moving into a communal
facility until forced by a crisis, many find their health improves with a
better diet and medication-management, Loveless said. “We have quite a few
rough moments,” she said. “Most are changed for the better. We take away a lot
of stressers.”

To ensure that doctor-prescribed diets and medications are
taken as ordered, a nurse leads the facility’s health department. Precautions
for residents rather than state regulation dictate hiring such professionals,
said Loveless, hired by Generations Management Group LLC, which also manages
two San Diego senior homes. Yet, lower occupancy required Loveless to layoff
three people in resident-serving jobs while adding two full-time marketers.

Aesthetics, though, rather than services, influence
decision-making by the children of potential residents. “It takes a ‘wow’ to
get them through the door,” she said.

To compete with fresher-looking rivals and revive occupancy
rates, a $1.2 million facelift is underway. The refurbishment will replace
care-worn carpets, add decorator paint to doorways and reconfigure a
little-used common room into a gym with equipment especially designed for the
elderly. The renovations are the most extensive since the then-incomplete
facility was purchased in 1989 for $10.5 million.

In deference to a dozen or so Orthodox residents, Heritage
Pointe keeps a kosher kitchen and its buses are stilled on Saturday. Mezuzahs
are in most doorways. Shabbat services and holidays are celebrated in a central
120-seat synagogue. Each year, about 50 teens adopt “grandfriends” as part of
their b’nai mitzvah. A small army of 900 community volunteers, organized
similarly to hospital and orchestra guilds, bring in speakers, raise
scholarship funds, shelve library books and shop for residents.

“A lot of wonderful things happen when the community is
involved and brings itself into the home,” said Loretta Modelevsky, of San
Clemente, a founding organizer and volunteer organizer. “Part of our heritage
is to take care of the elderly.”

Although no one who sought financial aide was turned away in
the last year, Loveless predicts more applicants for assistance as older
residents outlive the assets they liquidate to pay their way. Of 17 new
additions to the “scholarship” list, six are long-term residents whose financial
resources are depleted. “Scholarships” are awarded based on need. Some
applicants are rejected, such as one 84-year-old woman whose son owns
racehorses. A committee of the professional management company evaluates an
applicant’s tax records and those of their immediate family. The expectation is
that the family should contribute financial assistance before tapping
community-raised charity.

“The fact we are caring for people who are more frail is an
imperative for Heritage Pointe,” said Meryl Schrimmer, 71, of Laguna Beach, the
founding president, whose 93-year-old mother-in-law, Rita, is one of the oldest
residents. “Before, it was a social imperative to avoid isolation. Now,
physical care is even more important.”

When a Jewish home for the elderly was proposed in 1984,
some feared it would rob support from the Orange County Jewish Federation.
“Just the opposite has happened,” said Schrimmer, adding that the facility’s
eight support chapters are strengthening the Jewish community’s bonds.
“Heritage Pointe didn’t take away from anybody.”