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'What does woman want?'

Article-'What does woman want?'

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  • According to one expert, women are turning to their Ob-Gyns for entry-level cosmetic procedures and for advice on other, more-invasive procedures

Do you believe that cosmetic procedures are a natural extension of your practice given the sense of trust your female patients have with you?

We have an interesting rapport with the patient. When women are considering breast augmentation or some other procedure, they check with their gynecologist first. [They sense that] if they go in for a breast enhancement, augmentation or reduction, the [plastic] surgeon will comply with their demands. They want to get a more objective opinion first and that usually comes from their gynecologist. I only rarely hear about my patients getting cosmetic surgery afterwards. It's usually beforehand.

So they want strictly a "medical" opinion first before they are evaluated aesthetically?

I wonder if it's more medical or more of an "emotional permission." They want to make sure that they don't do something that might affect the way their husband perceives them. We've had a long-standing relationship. Many times, I've delivered all their children. They've been patients of mine for ten or 15 years.

I understand their family situation. They want to know, is this going to be something my husband is going to dislike, say, if they go for a breast augmentation. They know that their clothes will fit better, but they don't want to do anything to change the relationship negatively with their husband — hopefully [it will] enhance their relationship. Their gynecologist's is the most objective opinion they can get.

What would you say to plastic surgeons and cosmetic practitioners already in the field who may feel somewhat threatened by the entrance of Ob-Gyns such as yourself into the discipline?

If you compare the family practitioner doing some gynecologic care, those physicians become our primary source of referrals for people who have an abnormal pap smear or breast lumps or any type of gynecologic problem. So, for a gynecologist to feel threatened by a general practitioner doing pap smears, to me, is in many ways similar to a cosmetic surgeon feeling threatened by a gynecologist. There are different levels of cosmetic care. Gynecologists provide entry-level cosmetic procedures like Botox to the forehead — I don't venture to the lower face. We only do cosmetic-type sclerotherapy. We're introducing a lot of the patients to these procedures. And, invariably, when I provide Botox on a limited level, the patient asks me what else she could do to enhance her appearance. She may never have thought of doing an enhancement procedure, but having introduced her to this, now she may want to go for a facelift. In which case, we obviously refer her to someone more skilled in this area. Our referrals to plastic surgeons are at an all-time high.

What attracted you to your specialty in the first place? Do you feel a certain kinship that drew you to the care of women specifically?

I've always been a procedure-oriented type of person. Sort of handy. I did a year of general surgery and saw an opportunity in gynecology that was very interesting to me. Not only that it had a multitude of procedures, but it had mixed into it so many aspects of medicine. And we get the opportunity to deliver babies, which from a technical, medical standpoint is very challenging. But the best part is that, when you deliver a baby, you get to share the most important event in a woman's life. People think of getting engaged or being married as the zenith of their lives, but in actuality, it's having their children. I get to be there on these special occasions — so we develop a bond with our patients that no other specialty in medicine has the opportunity to fulfill.

What are your thoughts about the "beauty imperative" women seem to have – that some 92 percent of cosmetic patients are women?

Isn't it interesting that women still have a self-evaluation where beauty is so important? That's part of the culture and I don't think that's going to change.

You usher women patients through such pivotal milestones in their lives. Are you in a unique position to address aesthetic issues which can, psychologically and emotionally perhaps, better help them come to terms with their own aging process?

175 years ago, average longevity was about 47. Now some of my younger patients might live well into their late 90's. So we're already defying nature by virtue of technology — from antibiotics to control of cholesterol. We're taking advantage, safely, of what technology can offer. That's where anti-aging comes in. Everyone wants to live a very active older life. We can provide that for people. We screen for osteoporosis so they don't suffer a fracture. That's the medical aspect of it. But people want to feel youthful — to have bounce in their step and interest in being with their spouse. We provide that through hormone therapy and making sure that they have sexual health which is adequate. There are so many aspects of gynecology that lead patients into their maturing years in a much more favorable fashion. And that includes adding to them in a cosmetic sense. Every day, people tell me: "I don't like these spider veins I'm getting," or "I don't like these wrinkles." Now, I can give them entry-level cosmetic treatments to ward off some of these things and, if they want to go further, then we choose a plastic surgeon together.

Daniel J. Aronson, M.D. , practices obstetrics and gynecology in private practice in Mayfield Heights, Ohio.

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