Building A Better You

Cosmetic surgery can help make a better you, physically and emotionally.

Whenever plastic or cosmetic surgery is mentioned, some instantly conjure a host of horrifying mental pictures, from fictionalized surgical addictions on television or the big screen, to some frighteningly real celebrity disasters. Rarely do we glimpse the everyday people who comprise the majority of cosmetic surgery patients. From recovering from a personal loss to gaining the confidence to face the world as others do, patients who seek cosmetic surgery come from all walks of life.

“I think the public sometimes views patients that have cosmetic surgery as vain and insecure about themselves,” says Dr. James Koehler of Tulsa Surgical Arts. “Most patients are not like this, and are really just seeking to improve an area of their appearance that bothers them, that they cannot change. I think there is sometimes the idea that patients get ‘addicted’ to having things done. I have seen patients that try to use cosmetic surgery to solve their personal problems, but that is a rare situation. “

Much more common are stories like those of the following patients, all of whom elected to have cosmetic surgery, and shared their thoughts on the process.


Susie Monroe was, quite simply, tired of looking tired.

“My husband had died recently. I felt that I wanted to do something for myself,” the 67-year-old office manager says. Upon the decision to have a total facelift, Monroe sought out the skills of Dr. Joey Manduano, a Tulsa-area cosmetic and reconstructive surgeon.

“Susie wanted to look less tired and more youthful,” Manduano says. “She wanted to look how she felt. This desire matched her inner being.” According to the surgeon, it’s not unusual for his patients to have recently lost a loved one. However, he says, the motivations to have cosmetic surgery run the gamut, and procedures are sought for both emotional and medical reasons.

“Some patients are going through divorce or the loss of a loved one and are starting to date again or go out socially,” Manduano says. “Some are having vision difficulties because their eyelids are hanging down, or they want to remove extra skin after natural weight loss or gastric bypass … There are lots of different paths to the office. Sometimes, people say they have lost their jobs; they are older while everyone else is younger, and they need to get back into the job market. That reason has not been infrequent during the past few years’ economy.”

The most important thing before deciding to move forward with surgery, Manduano says, is establishing a definitive grasp on the patient’s expectations. “You have to get that out of the way right up front,” he says. “You must honestly assess what their expectations are, and whether these can be accomplished realistically and safely.”

After her procedure, Monroe says that despite her positive feelings about the surgery and her faith in Manduano, she experienced some post-operative anxiety – again, not infrequent, according to her surgeon. However, Monroe says that while she had bruising, there was no pain. “I must say I was a little scared when I first looked at myself right after surgery,” Monroe says. “I am not sure I realized what I would look like then. But boy, look at me now. I feel so much better about myself, and I feel so much younger. I now look like I feel.”

Manduano says patients often have post-operative anxieties and questions about pain, healing, and how long it will take before they can resume daily activities. “Luckily,” he says, “across the board, complications are less than one percent. Danger of anesthetic issues or surgical misadventures is about the same as getting in a car wreck. That doesn’t keep you from driving.”

Monroe describes Manduano and his staff as extremely supportive, and her experience went much like that of any other surgery, from pre-surgery consultation with an anesthesiologist to follow-up office appointments to assure that everything was healing as planned. Manduano says that post-operative support is especially important in the doctor-patient relationship.


Born with Poland Syndrome, a birth defect that causes an underdeveloped or absent pectoral muscle on one side of the body, Jessica Rafala had no right chest muscle, several underdeveloped ribs and no right breast. At 17, her insurance provider covered the cost of an implant. Unfortunately, that turned out to be a temporary solution. Twelve years and two children later, her implant collapsed, leaving her disfigured once more. This time, she was in for a nasty shock when her insurance provider declined to cover her procedure.

“I remember I sat at my kitchen table and just cried my eyes out,” the 29 year-old stay-at-home mom says. “I knew there was no way I could afford this reconstructive surgery on my own, and I was totally shocked that my insurance could deny me. I thought it was no fault of my own that I was born with this deformity, and now I was just supposed to live like this.”

After contacting as many surgeons around the country as she could locate – all of whom either said, “Good luck, but no” or worse, failed to reply at all – Rafala was put in contact with Dr. Angelo Cuzalina of Tulsa Surgical Arts. Cuzalina, director and past president of the American Academy of Cosmetic Surgery and an adjunct faculty member at Oklahoma State University, offered to perform Rafala’s surgery completely free of charge.

“Jessica’s case was special in that she had a congenital deformity with lack of development of one side of her chest, and problems after some attempted corrective surgery performed years ago elsewhere,” Cuzalina says. “Because it was a case that fell in a crack between cosmetic and reconstructive, insurance was of no help, and she could not afford the procedures required on her own. It was really just by chance that I came across her plea for help, and I found her story sincere and sad. I just felt the need to help if she could make it to Oklahoma.

“Most doctors do want to help whenever we can for people in need,” he adds. “We are just limited by time and resources, but it sure feels good when a situation works out that can really help someone who needs it.”

Rafala elected to have a breast lift on her left side with a silicone implant placed under the muscle, as well as to remove her collapsed implant and have a new one placed on her right side, where she had never developed a breast. On the day of her surgery, her doctor outlined the surgery areas with a marker and briefed her one last time on the procedure. After receiving a numbing agent and being hooked to an IV, she consulted with the anesthesiologist, whom she describes as “a really knowledgeable and warm person.”

“It really meant a lot to me, how concerned they were with making sure I was comfortable,” she says.

While many patients are nervous before undergoing surgery, Rafala says that excitement and gratitude overshadowed any apprehensions she might have felt heading in for such a procedure. “Once I met Dr. Cuzalina, I felt completely at ease. He made me feel so relaxed and treated me like a friend. He has such a kind heart and genuinely cares, and I felt that immediately when I met him. He took his time with me to answer all the questions, and I walked out of the office with nothing but positive feelings. After my surgery, my feelings were even more positive. The surgery and my results were even better than I could have ever imagined.

“This procedure and Dr. Cuzalina’s generosity totally changed my life,” she adds. “He gave me a gift better than anything I could open up, and it was my self-confidence. I finally feel ‘normal’ and I can look in the mirror and smile. That is something I could never repay him for. Nobody should have to live with a deformity, and I feel really blessed that Dr. Cuzalina was brought into my life.”


A 38-year-old entrepreneur from central Oklahoma, Thomas had always lived a very fit and healthy lifestyle. But as he aged, he began to notice that no matter how hard he worked out or how well he ate, some areas of his body simply refused to cooperate.
“The neck area, for example, would not slim down even if I reached my ideal weight,” he says. “Also, the dreaded love handle area seemed to only go away if I got my body fat to about eight percent, which is close to impossible to maintain with such a busy lifestyle the average person has with career and family.”

Thomas elected to have Vaser hi-definition liposuction performed on his abdomen, waist and neck with Dr. James Koehler. Koehler describes Thomas as both representative of many of his patients, and also as a good candidate for surgery. “He was in good shape and of stable weight. He was not using liposuction as a weight-loss procedure, and he works out regularly. He wanted to do this for himself and wasn’t doing it to please anyone else,” Koehler says.

According to the surgeon, that kind of motivation is important. He emphasizes that “a properly motivated patient does not rush into surgery, but has spent quite a bit of time thinking about the procedure and understands the risks of surgery.

“Cosmetic surgery can be very gratifying and life-changing in some situations for patients that are doing it for the right reasons.,” says Koehler. “Also, the goal of the surgery is to have an ‘improved you,’ not a ‘completely different you.’ Patients that have a poor body image that think that surgery is going to fix their life problems are not good candidates.”

Thomas admits that he had some negative preconceptions before having the liposuction procedure. “Prior to the procedure, my negative feelings of the cosmetic surgery I would receive were that you were getting results without working hard, and in return, that would make it hard to maintain a healthy lifestyle and workout habits,” he says. “My positive feelings were the quick and dramatic results that could be achieved. After the procedure, my positive perceptions were confirmed, while my negative perceptions turned out to be unrealistic. I have actually been so happy with the results that I increased my work-out schedule and started a healthier diet to make sure I maintain the look.”

Thomas experienced no complications from his surgery, he says. According to Koehler, “The most common complications are minor ones, which may include prolonged bruising, swelling, minor localized infection and minor wound separation. Each procedure has specific potential complications, which the surgeon will go over prior to surgery.  Major complications are infrequent but are a risk with any surgical procedure.”

His patient adds, “In my 17 years working in the health care field, I have never experienced a physician and staff as dedicated to patient results and satisfaction as Dr. Koehler and his office.”

Surgeons’ Suggestions

While every patient had a different surgeon, procedure and motivation for having plastic or cosmetic surgery, all agreed emphatically on one issue: Do your homework. Not only should you make educated decisions about potential procedures, you should always do some research about your surgeon. Manduano says this is particularly important, as some doctors who were medically trained in other areas have started performing cosmetic surgery on the side.

Manduano says that the most important question potential patients can ask is if their surgeon has hospital privileges. “A lot of people are doing these procedures in offices, where there’s no assurance of quality of care,” he says. “If you’re contemplating a physician, ask if they have privileges. You can’t get enough referral information. Don’t be swayed by the ads. One would have to ask, ‘Why aren’t referrals enough? Why are they advertising?’”

“Make sure you find the right doctor and somebody with the experience in the type of surgery you need,” Rafala cautions.

Thomas says, “There are several cosmetic surgeons that can perform the same procedures. However, the outcome and experience you receive will be dependent on the doctor you choose.”

– Tara Malone


More Cosmetic Surgery Topics

Top of the Heap: Most popular cosmetic procedures show little change.

Winning Skin: Skin perfecting procedures.

Perfect Pearly Whites: Cosmetic dentists work to craft the perfect smile.

 Sculpting Netherland: Women and men are seeking improvements in places not obvious to the naked eye.

 Quick Fixes: Refresh your look with little downtime.

 No Hair? No Problem! For men facing baldness, cosmetic surgery can be the answer.

 Nose Solutions: One easy procedure can provide the nose you’ve always wanted.

Previous articleNo Hair? No Problem!
Next articleNose Solutions


Please enter your comment!
Please enter your name here