What should you know before coming into any plastic surgery consultation? DR. DAVID ALESSI: Have a good idea as to what you don’t like or want to achieve. You don’t need to be a doctor—a good surgeon will interpret what you are trying to do. Minimal or no makeup is best, especially if you're getting fillers the same day. Research the doctor a bit and make sure they are board-certified.
Could you provide approximate recovery times for a few of the most common procedures? DA: There are different steps in the recovery process. For example, the straws in the nose after a rhinoplasty procedure are removed 2-3 days after the surgery, at which point the patient feels pretty good. The cast comes off at day 6—this is when most normal activities resume, except for no heavy lifting for 2 weeks. Press photos for celebrities occur in about 6 weeks.
For a facelift or eyes, there is a lot of swelling [in] the first 3 days. Most swelling is gone in one week, bruising in two weeks, and press photos [can take place] in 3-4 weeks. For laser, the patient will look bad for 6 days. For noninvasive treatments, such as Thermage, botox, and fillers, there is no down time.
Speaking in general—discuss the most invasive procedures vs. the least invasive? DA: The most invasive is a deep-plane facelift or a true midface lift. The facial tissues are released from the underlying skeleton and re-supported higher. This stage looks great, but the patient stays swollen for 3-4 weeks. Rhinoplasty involves cutting and moving the bone and it can be fairly invasive. The least invasive procedures are botox, fillers, and thermage.
In terms of transgender patients specifically—what about bringing in celebrity photos/copying celebrity body parts? Does that work? What celebrities are the most coveted? DA: A picture of a celebrity may help in terms of having a realistic discussion of what is possible, and helps the doctor to understand what the patient wants. I have not seen a trend that follows a particular celebrity in the transgender community, but many patients bring in photos of features they desire of various celebrities.
What advice do you have for someone who is thinking about gender reassignment? What is involved? How long is the process and what are the costs? DA: They need to spend several months to a year seeing a couple of competent psychologists in order to receive an approval for their reassignment in the form of a letter. Prior to the start of surgery, the patient will have to go through several months of hormone therapy. What is performed on the patient depends on the individuals themselves. For instance, if the patient has a masculine face, then they will want a [to have] surgery [for] a more feminine face. Next will come breast implants and voice box surgery. At some point after, the true gender reassignment surgery will occur. Each patient will need something different and the surgery ranges from $40K to $120K.
Are there any other procedures you think Caitlyn Jenner should explore? DA: The facial features could be more delicate. However, it is impossible to say that now, since she still has post-op swelling and the pictures [in Vanity Fair] have been airbrushed.