8 million); "chemical peel" (1 million); "microdermabrasion" (828,000); laser hair removal (783,000); and "sclerotherapy" (590,000). Among the various kinds of cosmetic surgery, there are several that are not at all related with vanity, but instead are corrective in nature and dealing with a serious impairment on the part of the patient. For example, an article in HIV Medicine (published by the British HIV Association) discusses facial lipoatrophy which HIV patients often are embarrassed by. The problem is a quality of life issue, and not just that a person wants to look good and acceptable. Facial lipoatrophy can cause an erosion of "self-image and self-esteem," the article explains.

What is facial lipoatrophy? The Web site www.aidsmeds.comexplains that facial lipoatrophy (also called "facial wasting") is not life threatening, but is "stigmatizing" and can contribute "significantly" to an HIV patient's depression. It is believed to be a side effect of some of the anti-HIV therapies that are used on patients. Facial lipoatrophy actually refers to an "abnormal loss of body fat" right under the skin; and the most embarrassing place for this loss of fat to occur is in the face, although lipoatrophy can also show up in the legs, arms, buttocks and around the waist. An HIV patient with facial lipoatrophy suffers from sunken cheeks; the cheeks appear to be hollow, and the facial muscles can be seen and felt through the skin, the article explains on www.aidsmeds.com.

A possible remedy for facial lipoatrophy is presented in the HIV Medicine article, which reports the results of a study of the long-term safety and efficacy of "injectable poly-L-lactic acid (PLLA) to correct the sunken cheeks and hollow facial appearance. Thirty HIV patients who showed obvious signs of facial lipoatrophy agreed to undergo injections of PLLA. None of these had ever received treatment for their facial lipoatrophy. Of those patients receiving injections, some suffered from mild symptoms, some had severe symptoms; 27 of the original 30 HIV patients returned for the remainder of the study, which consisted of three sessions, two weeks apart. There was one case of infection and nine cases of "injection-site nodules." All the patients had nodules but aside from the nine mentioned in the previous sentence, the rest of the nodules were very small. The results of the study showed that the injections did in fact help the patients' faces retain some or much of their original fullness, but the article recommends that for future injections, a more "dilute concentration of PLLA" should be used. The thought is that to heavy a concentration of PLLA into the face caused some of the nodules to appear, although in the end of the study, none of the patients' nodules was severe enough to cause embarrassment. The bottom line is, this kind of surgery for HIV patients is a classic example of necessary cosmetic surgery, and it brings relief to...

An article in USA Today points out that some insurance companies won't cover plastic surgery when it involves correcting "defects of the face, skull, and neck." The won't cover those important surgeries because, according to the insurance companies, those are "merely cosmetic," the article goes on, but in fact doctors and families classify those kinds of surgeries as "reconstructive and functional in nature." The appearance of a person, especially a person with mental problems, can "positively or negatively influence his or her ability to socialize," according to surgeon Steven Buchman, who authored a report for the American Society of Plastic Surgeons.
Children with "severe" mental disabilities "undoubtedly benefit" from plastic surgery to restore their faces to something far less unsightly; that in turn, helps the mentally retarded child "lead a fuller life," Buchman continues in his report. When a mentally handicapped child is accepted by his or her peers parents and teachers, they learn better. Also, when a child has a physical deformity a teacher may "underestimate" the intellectual ability of that child, and hence, the teacher may have a lower expectation for the child.

Meanwhile, the most "significant advance" in facial reconstructions in the last 30 years or so is facial "transplantation," according to an article in the Lancet (Butler, et al., 2006). Indeed, a man's face was partially transplanted into another man's face in France in 2005. This is extreme cosmetic surgery, and involves highly technical advances in surgery, but apparently the patient receiving a new face has healed quickly, has experienced "gradual recovery of function" along with psychological acceptance of the graft after twelve weeks. This is worth mentioning for this paper because it is an example of how far medical science has come in the past few years. There are risks in partial facial transplants, the authors indicate, but the next step is to "identify the potential risks," and development strategies to minimize those risks.

Works Cited

Aids / Meds. "Changes to Your Face (facial lipoatrophy)." Retrieved July 23, 2007, at http://www.aidsmeds.com/articles/lipoatrophy_4794.shtml.

Butler, Peter E.M. "Managing the risks of facial transplantation." The Lancet Vol. 368 (2006):

Moyle, G.J.; Brown, S.; Lysakova, L.; & Barton, S.E. "Long-term safety ad efficacy of poly-L-

Lactic acid in the treatment of HIV-related facial lipoatrophy." HIV Medicine / British HIV

Association Vol. 7 (2006): 181-185.

Pouliot, Janine S. "New Vacation Souvenir: A Face-Lift." Prevention 56.8 (2004): 38-38.

Simon, Mashdaun D. "More Blacks Getting Nipped and Tucked."…