Health and beauty features

DOCTORS warn that women should be warned about the risks of cosmetic genital surgery, which they believe may be fuelling women's insecurity about their bodies. Demand for cosmetic genital surgery (genitoplasty) is increasing and the number of labial reductions in the NHS has doubled in the past five years.

However, writing in the British Medical Journal, Doctors, Lih Mei Liao and Sarah Creighton, from UCL Elizabeth Garrett Anderson Institute for Women's Health, argue that decisions about surgically altering genitalia may be based on misguided assumptions about normal dimensions. Surgery carries risks, such as loss of sensitivity, and the long-term benefits are unclear.

They add that the increased demand for cosmetic genitoplasty may reflect a narrowing social definition of normal or a confusion of what is normal and what is idealised. The worry is, provision of genitoplasty could narrow acceptable ranges further and increase the demand for surgery even more.


source: www.manchestereveningnews.co.u

Cameron Diaz was Against Having Cosmetic Surgery

Although she had her nose fixed last year, Cameron Diaz said it was for medical reason and that she has no plans to have any more work done. The 34-year old actress was quoted as stating that it was sick that people are having surgery to look like celebrities. In addition, the actress said she finds it unnerving when she looks at women who have had plastic surgery.

Diaz said she believes beauty comes from the inside and she has no plans to go under the knife as she ages because she didn’t want to lose the person she is because of plastic surgery.

The successful actress is the voice of Princess Fiona in the Shrek trilogy.

source:www.carefair.com

Cosmetic Surgery Goes Ethnic

WASHINGTON -- The advertising slogan is a sly double entendre: Washington's Cultura Medical Spa bills itself as ``a place where it's appropriate to treat people based on the color of their skin.''

Founded six years ago by two African American physicians -- cosmetic dermatologist Eliot F. Battle Jr., an expert in laser treatments, and Monte O. Harris, a board-certified otolaryngologist who specializes in rhinoplasty and other facial plastic surgery -- Cultura is one of the first centers in the country to focus on the burgeoning field known as ``ethnic plastic surgery.''

Two-thirds of the center's patients are nonwhite, many of them black women who in increasing numbers are seeking such procedures as nose jobs and laser hair removal that until recently were largely the province of well-heeled white women. Many of these patients, doctors say, are also seeking treatments that seek to enhance -- not obscure -- their racial or ethnic characteristics.

Although white women continue to dominate the ranks of cosmetic medicine, the number of black, Hispanic and Asian patients has escalated dramatically in the past five years, according to officials at the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgery.

Experts say the growth reflects increased acceptance of such procedures within these groups, greater economic clout and larger numbers of minority specialists whom many ethnic patients regard as more attuned to their needs.

In 2002, according to statistics compiled by the ASPS, minorities accounted for 16 percent of plastic surgery patients. Four years later minorities accounted for 23 percent of patients.

The rise in the number of ethnic patients is noticeable in Washington, cosmetic surgeons say, because of its diverse population and high levels of disposable income in some minority groups.

Doctors in such cities as Baltimore, Chicago and Philadelphia -- places which, like Washington, are not considered hotbeds of plastic surgery -- are reporting similar increases. In the past few years, Chicago's Northwestern University opened a Center for Ethnic Skin, while Henry Ford Hospital in Detroit launched a Multicultural Dermatology Clinic.

Surgeons say that minority women request many of the same procedures as whites, but there are some differences. Surgery to create a crease in the eyelid to give the eye a more open look is popular among Asian American women, while breast reduction, virtually the only cosmetic procedure that may be covered by insurance because it is usually considered functional, is popular among African Americans.

Some patients say minority physicians are more sensitive to their aesthetic concerns and have greater skill treating darker skin, which is more prone to scarring and pigment changes than white skin.

``I was looking for a doctor with a laser background'' who was experienced with African American skin, said Miriam Rudder, 50, a Cultura patient since 2001, when she underwent laser hair removal on her underarms. ``I didn't want to get burned.''

Ten years ago, nonwhite women -- and whites with a suntan -- were warned that they risked permanent scarring if they underwent laser hair removal as Rudder did, cosmetic dermatologists say.

In those days, Battle said, there were few cosmetic options available to women of color. Mostly ``what we could offer was a bleaching cream and Cetaphil,'' Battle said, referring to a skin cleanser often recommended by dermatologists to patients of all races. (Bleaching cream is used to even skin tone and minimize the appearance of dark patches.)

Battle, 50, left a career in international marketing at IBM when he was 34 to enter medicine. A graduate of Howard University and its medical school, he completed a laser dermatology fellowship at Harvard Medical School and displays an evangelical fervor about ethnic skin care. While at Harvard he helped develop laser treatments now widely used to treat dark skin.

First-generation lasers, he recalls, were designed for light skin and dark hair -- and the risks of scarring dark or tanned skin were well-known. But the newer lasers that he helped pioneer mean ``I can treat the darkest African and Indian skin safely.''

Equal parts glossy retail cosmetics counter, candle-scented day spa and white-coated medical practice with a stable of 30 lasers, Cultura treats about 85 patients six days a week.

They include former Miss America Ericka Dunlap, who flies in from Nashville for treatments of acne flare-ups and other skin care; tennis stars Venus and Serena Williams; and basketball stars Patrick Ewing and Alonzo Mourning. Some patients have come from as far as Turkey, Iran and Brazil.

``This place is a mini-U.N.,'' Battle said, referring to its clientele and staff.

The growing acceptance of cosmetic procedures reflects a change in attitude, particularly in the black community, surgeons say.

Until about five years ago, said Chicago plastic surgeon Julius W. Few, cosmetic surgery was typically regarded as worse than frivolous in the African American community -- and often associated with the race-effacing look of Michael Jackson.

``There really was a sense of taboo, that if you were looking at plastic surgery you were seen as being ashamed of your ethnicity,'' noted Few, an associate professor of surgery at Northwestern. ``I've seen a tremendous swing.''

Many patients, he said, flatly tell him they don't want to ``look white. Most people want to preserve their original look,'' while making subtle changes.

``There are indeed cultural differences,'' observed Baltimore plastic surgeon Ricardo Rodriguez, chief of plastic surgery at Greater Baltimore Medical Center.

White women favor a thinner silhouette, Rodriguez said, ``while Hispanic and African American women want to be more curvy.''

Even the terminology differs: Whites often disparagingly refer to their ``saddlebags'' -- fat deposits on the lower hip and upper thigh -- while black and Latina women ``never use that word,'' Rodriguez said. They call them ``thighs'' and rarely request liposuction there.

Bahman Teimourian, a clinical professor of plastic surgery at Georgetown University School of Medicine, said it behooves surgeons of all races to be knowledgeable about cultural standards.

A chin that might be considered weak by traditional American standards and a candidate for plastic surgery, Teimourian said, is seen as beautiful among people from the Middle East, where a small chin is regarded as a desirable sign of femininity.

Recently Teimourian said he repaired the nose of an African American patient who was unhappy with the ``very Caucasian nose'' a previous surgeon had given her. Teimourian said he removed some cartilage from behind the woman's ear to reshape her nose to better fit her features.

Moving beyond ``Eurocentric'' notions of beauty has been integral to Cultura's success and is central to its philosophy, said Harris, 40, a graduate of Case Western Reserve University School of Medicine who trained at the University of Michigan.

``Half the world's going to be brown-skinned by 2050,'' he noted. ``We're not going to close our eyes to all those patients.''

Similarly, he said, Cultura has been catering to men, who account for about 10 percent of its clients. Many have been sent by wives or girlfriends for ``beard management'' and treatment of ingrown hairs.

Eric Ellerbee, 44, a UPS driver who for years has made regular deliveries to Cultura, is among its male patients.

Last fall, he received complimentary injections of Restalyne, a cosmetic filler, to soften the lines that run from the side of his nose to the corner of his mouth and are among the first signs of facial aging.

``I didn't even tell my wife I'd had it done,'' said Ellerbee. ``I wanted to see if she noticed.'' (She did and was impressed, he said.)

But a 47-year-old African American nurse said she would never tell her mother and sisters about the collagen injections, facelift, tummy tuck and breast implants she received from Rodriguez, which cost her $21,000.

``My mother says, `You look different,' but I would not tell her -- she would not be accepting,'' said the woman, who did not allow her name to be used. ``My husband and children know, and they're fine with it.''

Ellerbee said he's so pleased with the results that he keeps ``before'' and ``after'' pictures of himself on his cellphone.

``Everyone wants to age gracefully,'' he said, adding that Restalyne didn't hurt nearly as much as the tattoo he got years earlier.

source: www.cantonrep.com

Plastic surgery can be last-resort

The beauty industry is all about working with what you've got. Enhancing the good and disguising what we don't like. But what happens if these treatments just aren't enough to satisfy us? What if the image we have of ourselves is marred by something body cream or makeup just won't help?

This is when the question of plastic surgery becomes a factor for regular people, not just celebrities. Crooked noses, excess skin after major weight loss, uneven breasts, fat pockets and jowls are a few reasons why people all over the Maritimes come to Halifax to restore their looks and self-esteem through plastic surgery.

Atlantic Canada's only private plastic surgery clinic, The Landings Surgical Centre, is on Halifax's swanky waterfront at Bishop's Landing, open since the summer of 2005.

The clinic has an understated entrance. Once inside, a friendly receptionist greeted me in the waiting area, a peaceful and luxurious area befitting a private cosmetic-surgery clinic. This atmosphere continued into the back offices and consultation rooms, until I reached the doors to the operating area.

It was strange to walk from a polished office to a silent, sterile hospital, by the swing of a few doors. Once past the doors, I may as well have been in the QEII.

Richard Bendor-Samuel, one of the physicians and founders of The Landings, has been in plastic surgery for more than 15 years, and is an assistant professor of surgery at Dalhousie University. As he spoke to me from his office in the clinic, he said there has been a major change in attitude toward plastic surgery, mainly due to American media.

"Cosmetic surgery has become a lot more popular. TV shows have made it more acceptable, but not really explained it," he said.

He says that although plastic surgery is a now more common and safe way to correct issues such as drooping breasts and excess skin from weight loss, it's not necessarily for everyone. You need to be healthy and mentally prepared for the surgery. And although he hasn't seen it very often, there are people who become fixated on additional surgeries leading to addiction to corrective procedures.

But as plastic surgery becomes more acceptable and safe, Bendor-Samuel saw the need for a private plastic surgery clinic in Halifax to give people an option for shorter wait lists, and a place to have surgery in a quiet atmosphere.

Although there has been backlash against the private clinic, Bendor-Samuel says the clinic doesn't take away from subsidized health care or allow people to jump queues.

The individual either pays for plastic surgery performed at the hospital, if it is for cosmetic reasons, or it is done for medicinal reasons and is covered by the public health-care system. The difference is there is a longer wait to have it done at the hospital.

The clinic has kept busy since its opening in 2005. Jennifer (not her real name), a single woman in her mid-20s, last September had liposuction, one of the most common procedures performed at The Landings by Dr. Bendor-Samuel.

"I'm not a huge person, but I've always had a big butt and hips," said Jennifer. She struggled to find clothes that fit properly, having a small upper body and torso, with a larger bottom. She said although she and her friends would joke about it, it bothered her enough to find a solution.

Although diet and exercise kept her in great shape, her hips remained the same. After investigating the pros and cons of having liposuction performed on her hips, she decided to go for it.

She paid $4,800 for the procedure, had bruises all the way to her feet, wore an undergarment for swelling for six weeks and might still be swollen for another year, which is normal.

Jennifer took a week's vacation from work, and still hasn't told some of her closest friends, or even her father. When asked if she would do it again, Jennifer says, "In a heartbeat."

In fact, she says knowing the results she received from the procedure she would have paid double the cost; she says it changed her life. She wore a bathing suit and shorts for the first time since childhood on a recent trip to Cuba.

After the removal of 2.5 litres of fat from her hips and thighs, she is down 15 pounds and four pant sizes. She said the staff made sure she understood the importance of maintaining a healthy body. If she were to gain any weight, dents in the flesh would remain where the fat was initially removed, leaving her with lumpy thighs and uneven skin.

Plastic surgery is a last resort for many people, like Jennifer. It's the remaining option after all else has failed.

It's expensive, painful and a serious decision not to be taken lightly. You need to be in good health, have realistic expectations and consider your future.

If you're planning on having children, a tummy tuck or breast implants may not be the best option. If you are planning to lose weight, wait until you've reached your goal, then talk to a surgeon. If you are set on surgery, quit smoking now in order to heal better and faster after surgery.

Bendor-Samuel says there are a few ways to avoid future surgery. Maintain a healthy body weight and avoid major weight gains and losses to avoid excess skin. And always wear a bra: gravity will always work against you.

Keep in mind you'll have to set aside time for recovery. Vacation time and a buddy to help you out for the first few days after surgery are often needed.

If plastic surgery is something you are considering, do your research, have a thorough consultation and plan ahead. Even though cosmetic surgery is safer and more common than ever before, it's a serious medical procedure.

Denise Surette would like to thank Jennifer for sharing her personal story. She is an esthetician at HS Studio and a journalist living in Timberlea.

source: www.hfxnews.ca

Plastic surgery for minorities

W ASHINGTON – The advertising slogan is a sly double-entendre: Washington’s Cultura Medical Spa bills itself as “a place where it’s appropriate to treat people based on the color of their skin.”

Founded six years ago by two black physicians – cosmetic dermatologist Eliot Battle Jr., an expert in laser treatments, and Monte Harris, a board-certified otolaryngologist who specializes in rhinoplasty and other facial plastic surgery – Cultura is one of the first centers in the country to focus on the burgeoning field known as “ethnic plastic surgery.”

Two-thirds of the center’s patients are non-white, many of them black women who in increasing numbers are seeking such procedures as nose jobs and laser hair removal that until recently were largely the province of well-heeled white women. Many of these patients, doctors say, are also seeking treatments that seek to enhance – not obscure – their racial or ethnic characteristics.

Although white women continue to dominate the ranks of cosmetic medicine, the number of black, Hispanic and Asian patients has escalated dramatically in the past five years, according to officials at the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgery.

Experts say the growth reflects increased acceptance of such procedures within these groups, greater economic clout and larger numbers of minority specialists whom many ethnic patients regard as more attuned to their needs.

In 2002, according to statistics compiled by the American Society of Plastic Surgeons, minorities accounted for 16 percent of plastic surgery patients. Four years later, minorities accounted for 23 percent of patients.

The rise in the number of ethnic patients is noticeable in Washington, cosmetic surgeons say, because of its diverse population and high levels of disposable income in some minority groups.

Doctors in such cities as Baltimore, Chicago and Philadelphia – places which, like Washington, are not considered hotbeds of plastic surgery – are reporting similar increases. In the past few years, Chicago’s Northwestern University opened a Center for Ethnic Skin, and Henry Ford Hospital in Detroit launched a Multicultural Dermatology Clinic.

Surgeons say that minority women request many of the same procedures as whites, but there are some differences. Surgery to create a crease in the eyelid to give the eye a more open look is popular among Asian women, while breast reduction, virtually the only cosmetic procedure that may be covered by insurance because it is usually considered functional, is popular among black women.

Some patients say minority physicians are more sensitive to their aesthetic concerns and have greater skill treating darker skin, which is more prone to scarring and pigment changes than white skin.

“I was looking for a doctor with a laser background” who was experienced with black skin, said Miriam Rudder, 50, a Cultura patient since 2001, when she underwent laser hair removal on her underarms. “I didn’t want to get burned.”

Ten years ago, non-white women – and whites with a suntan – were warned that they risked permanent scarring if they underwent laser hair removal as Rudder did, cosmetic dermatologists say.

In those days, Battle said, there were few cosmetic options available to women of color. Mostly “what we could offer was a bleaching cream and Cetaphil,” Battle said, referring to a skin cleanser often recommended by dermatologists to patients of all races. (Bleaching cream is used to even skin tone and minimize the appearance of dark patches.)

Battle, 50, left a career in international marketing at IBM when he was 34 to enter medicine. A graduate of Howard University and its medical school, he completed a laser dermatology fellowship at Harvard Medical School and displays an evangelical fervor about ethnic skin care. While at Harvard, he helped develop laser treatments now widely used to treat dark skin.

First-generation lasers, he recalls, were designed for light skin and dark hair – and the risks of scarring dark or tanned skin were well-known. But the newer lasers that he helped pioneer mean “I can treat the darkest African and Indian skin safely.”

Equal parts glossy retail cosmetics counter, candle-scented day spa and white-coated medical practice with a stable of 30 lasers, Cultura treats about 85 patients six days a week.

They include former Miss America Ericka Dunlap, who flies in from Nashville for treatments of acne flare-ups and other skin care; tennis stars Venus and Serena Williams; and basketball stars Patrick Ewing and Alonzo Mourning. Some patients have come from as far as Turkey, Iran and Brazil.

“This place is a mini-U.N.,” Battle said, referring to its clientele and staff.

The growing acceptance of cosmetic procedures reflects a change in attitude, particularly in the black community, surgeons say.

Until about five years ago, said Chicago plastic surgeon JuliusW. Few, cosmetic surgery was typically regarded as worse than frivolous in the black community – and often associated with the race-effacing look of Michael Jackson.

“There really was a sense of taboo, that if you were looking at plastic surgery you were seen as being ashamed of your ethnicity,” said Few, an associate professor of surgery at Northwestern. “I’ve seen a tremendous swing.”

Many patients, he said, flatly tell him they don’t want to “look white. Most people want to preserve their original look,” while making subtle changes.

“There are indeed cultural differences,” said Baltimore plastic surgeon Ricardo Rodriguez, chief of plastic surgery at Greater Baltimore Medical Center.

White women favor a thinner silhouette, Rodriguez said, “while Hispanic and African-American women want to be more curvy.”

Even the terminology differs: Whites often disparagingly refer to their “saddlebags” – fat deposits on the lower hip and upper thigh – while black and Latina women “never use that word,” Rodriguez said. They call them “thighs” and rarely request liposuction there.

Bahman Teimourian, a clinical professor of plastic surgery at Georgetown University School of Medicine, said it behooves surgeons of all races to be knowledgeable about cultural standards.

A chin that might be considered weak by traditional American standards and a candidate for plastic surgery, Teimourian said, is seen as beautiful among people from the Mideast, where a small chin is regarded as a desirable sign of femininity.

Recently Teimourian said he repaired the nose of a black patient who was unhappy with the “very Caucasian nose” a previous surgeon had given her. Teimourian said he removed some cartilage from behind the woman’s ear to reshape her nose to better fit her features.

Moving beyond “Eurocentric” notions of beauty has been integral to Cultura’s success and is central to its philosophy, said Harris, 40, a graduate of Case Western Reserve University School of Medicine who trained at the University of Michigan.

“Half the world’s going to be brown-skinned by 2050,” he said. “We’re not going to close our eyes to all those patients.”

Similarly, he said, Cultura has been catering to men, who account for about 10 percent of its clients. Many have been sent by wives or girlfriends for “beard management” and treatment of ingrown hairs.

Eric Ellerbee, 44, a UPS driver who for years has made regular deliveries to Cultura, is among its male patients.

Last fall, he received complimentary injections of Restalyne, a cosmetic filler, to soften the lines that run from the side of his nose to the corner of his mouth and are among the first signs of facial aging.

“I didn’t even tell my wife I’d had it done,” Ellerbee said. “I wanted to see if she noticed.” (She did and was impressed, he said.)

But a 47-year-old black nurse said she would never tell her mother and sisters about the collagen injections, facelift, tummy tuck and breast implants she received from Rodriguez, which cost her $21,000.

“My mother says, ‘You look different,’ but I would not tell her – she would not be accepting,” said the woman, who did not allow her name to be used. “My husband and children know, and they’re fine with it.”

Ellerbee said he’s so pleased with the results that he keeps “before” and “after” pictures of himself on his cell phone.

“Everyone wants to age gracefully,” he said, adding that Restalyne didn’t hurt nearly as much as the tattoo he got years earlier.

source: www.fortwayne.com

Cosmetic Surgery

Medical wellbeing and private treatment in Thailand abetetrtravelandtours now offer a wide range of cosmetic and non cosmetic surgery.Tailor made packages including flights,hotels and transportation.

The Smsworlds Group have now launched their latest exciting website with www.abettertravelandtours.com specialising in the far east and being based in Phuket Thailand.

As part of the services being provided is cosmetic and non cosmetic surgery,with prices much lower than europe and america you wont find a better place for your cosmetic surgery.

The work will be undertaken by one of thailands leading surgeons Dr V,get away from your home town and relax and recuperate on the white sands of Phuket after you have received your cosmetic surgery.

Thailand is now becoming one of the leading players in medical tourism with their combination of excellent surgeons and exotic places to relax.We have alsoadded some new spa and laser treatments to our services.

source: pr-gb.com

Cosmetic Surgery Procedures Understanding the Risks

For those who wish they could look just a little younger or change an unflattering feature, they may want to consider cosmetic surgery. A minor adjustment can smooth away the wrinkles in your brow; more elaborate procedures can "lift" your sagging face or remove excess fat from your thighs or stomach. Properly performed, cosmetic surgery can have a profound effect on how you look and feel. The boost in confidence and self-esteem could affect virtually every aspect of your life.

But just because an operation is labeled cosmetic doesn't mean it is risk-free. Of course, some procedures are chancier than others, but every operation carries some possibility of complications. Infection, disfigurement, paralysis, and even death can occur as a result of virtually any kind of surgery. Such undesirable consequences of cosmetic procedures are estimated to be no higher than those of other types of surgery.

Below are six of the most common procedures for which patients visit cosmetic surgeons. All of them carry risks, from scarring to facial paralysis and even, in the case of liposuction, death. Choosing a highly skilled surgeon can drastically reduce the odds of a mishap.

1. Eyebrow Lift - This procedure minimizes brow wrinkles, droopy eyebrows, hooded eyes, and frown lines by removing excess tissue and tightening the skin on the forehead. Recovery time is 7 to 10 days at home (less if performed with an endoscope, which requires fewer incisions); bruising lasts two to three weeks. Permanence is about 5 to 10 years. Risks include loss of facial motion, muscle weakness, infection, scarring, and asymmetrical look.

2. Eyelid Surgery (blepharoplasty) - This procedure corrects puffy bags under eyes and sagging lids above by removing excess fat, skin, and muscle. Recovery time is 7 to 10 days at home; no reading allowed for two or three days, and no contact-lens use for 14 days or longer; bruising and swelling last for several weeks. Permanence is several years; sometimes for life. Risks include temporary blurred or double vision, infection, bleeding, swelling, and dry eyes; permanent difficulty in closing eyes completely; drooping of lower lids necessitating further surgery; and permanent blindness.

3. Face-lift (rhytidectomy) - This procedure improves sagging facial features, including loose jowls and crepey neck, by removing excess fat, tightening muscles, and redraping skin. Recovery time is 10 to 14 days at home; bruising lasts two to three weeks. Permanence is about 5 to 10 years. Risks include facial paralysis, infection, bleeding, excessive scarring, and drastic change in facial appearance.

4. Liposuction - This procedure changes body shape by removing fatty deposits. It is performed by sucking fat out through a tube connected to a vacuum device. In tumescent liposuction, the area is first infused with a saline-anesthetic solution to enable fat to be removed with less swelling and bruising. In ultrasound liposuction, sound waves are used to liquefy fat before removing it. Recovery time is 1 to 2 weeks at home; swelling and bruising last one to six months or longer. Permanence is lifetime, with sensible diet and exercise. Risks include rippling or sagging of skin, pigment changes, skin damage, excessive fluid loss leading to shock, infection, burns, and cardiac arrest. Complications from liposuction have been the cause of several deaths.

5. Nose Surgery (rhinoplasty) - This procedure reshapes the nose and may reduce breathing obstructions by cutting or reshaping cartilage or bone or by grafting bone. Recovery time is 1 to 2 weeks at home initially; complete healing may take a year or more. Permanence is lifetime. Risks include infection and damage to tiny blood vessels, causing red blotches on nose; may require repair surgery.

6. Tummy Tuck (abdominoplasty) - This procedure flattens a sagging stomach by removing excess fat and skin and tightening muscles. Recovery time is 2 to 4 weeks at home; no strenuous activity for four to six weeks; scars may be highly visible for 3 months to two years. Permanence is lifetime, with sensible diet and exercise. Risks include blood clots, infection, and scarring; may require a second operation.

Even when your cosmetic surgery proceeds without a hitch, you may not be totally delighted with the outcome. Digital photography and computer imaging programs can give you a flattering preview of what your new nose, face, or abdomen may look like, but your appearance after surgery depends to a large extent on the skill of your surgeon - as well as factors unique to you: skin type, bone structure, healing ability, and overall health.

If you find yourself having unrealistically high expectations about what your new look will do for you, it would be wise to mention this to your surgeon. An experienced surgeon should help you prepare for the fact that the outcome of the surgery doesn't always meet the expectations of the patient.

source: www.dentalplans.com