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PLASTIC and reconstructive surgeons have claimed to have improved the lives of millions of patients each year. Depending on what needed to be worked upon on the body parts, several patients have also said they have got reasons to smile as their confidence had been either restored or boosted.

Patients with congenital malformations such as cleft lip and cleft palate, disfiguring wounds, and profound burn injuries, have had plastic surgeons to thank for giving them their lives back. Those requiring reconstruction surgery for cancers and other chronic conditions, have also testified to the work of plastic surgeries.

As life changing as cosmetic surgery is, experts also believe that they could be life altering, depending on a number of variables.

Although there is a dark side to cosmetic surgeries, beauticians have insisted that the procedures do have the transformative powers that make life better for their clients.

Last year, English footballer, Wayne Rooney, admitted to having cosmetic surgery to make him more attractive. The Manchester forward went under the knife for a hair transplant, a procedure said to have been encouraged by his wife, Coleen. The cost of the operation was said to be £12,000.

Modupe Ozolua, a self-professed cosmetic surgery pioneer in Nigeria who has been in the practice since 2001, claimed that her body enhancement company has "successfully transformed the bodies of hundreds of men, women and children."

According to her, clients at the end of the procedures leave with improved bodies, armed with "newly found confidence and are psychologically prepared to face the world with a new vigour."

With aesthetic laser machines, patients could undergo permanent hair removal, vein therapy and skin rejuvenation procedures, among others.

Reasons for choosing to go under the knife vary, Nigerian Tribune was told. Dr Yemi Hakeem, an expert in one of the cosmetic surgery outfits in Nigeria, said external and internal motivators propel people to go for cosmetic surgery.

External motivators such as age discrimination, direct or subtle coercion by a spouse, parent or boss, peer pressure, among others, make people want to reconstruct their bodies.

Social anxiety, insecurity issues, shame, the wish to alter a specific disliked feature; the yearning for a more youthful look, and in some cases, the hope to create a strong, powerful appearance that will facilitate career advancement, have also been attributed as reasons for going under the knife.

Cosmetic surgery, historians said, began in the 600 BC, when a Hindu surgeon reconstructed a nose using a piece of cheek. By 1000 AD, rhinoplasty became common. In the 16th century, Gaspare Tagliacozzi, known as "the father of plastic surgery," reconstructed noses slashed off by swords during duels by transferring flaps of upper arm skin. This procedure was also used to correct the saddle nose deformity of syphilis, historians noted.

As civilisation progressed, Pierre Desault, in 1798 coined the term plastic surgery, from the Greek 'plastikos' (fit for molding), as a label for procedures to repair facial deformities. By the 19th century, developments in anaesthesia and antisepsis made plastic surgery safer and allowed for improvements in technique, according to those who practise this procedure.

By 2005, 10.2 million cosmetic procedures were recorded to have been performed in the United States, an increase of 11 per cent from 2004 and a 38 per cent compared with 2000. As plastic surgery became popular and more acceptable, more Nigerians began to embrace the procedure.

It seems though, that the late First Lady of Nigeria, Mrs Stella Obasanjo brought the procedure to limelight, when she was alleged to have gone for a tummy tuck that supposedly took her life. Ever since that time, hundreds of Nigerians have undergone aesthetic surgeries, unconfirmed reports stated.

Aesthetic surgeries are lucrative, Dr Stanley Okoro, who has facilities in Abuja, Lagos and Atlanta, Georgia, told the Nigerian Tribune via a Skype interview.

In 2005, total physician fees for cosmetic procedures, not including anaesthesia, operating room facilities, and other related expenses, were estimated at $9.4 billion.

Dr Okoro said charges for aesthetic surgeries depend on the type of surgery being done, the expertise and experience of the surgeon. On the average, a plastic surgery could cost as much as N2million, he said.

In Nigeria he added, more 'Lagosians' were opened to cosmetic surgery as against women in other parts of the country like Abuja.

As open as the women were, he continued, they were more discreet. The fear of being judged by their friends and family, Dr Okoro said, could be a reason for this.

In his opinion, "explosion of women liberation" has given rise to cosmetic surgery in Africa.

The fact that more women are becoming more financially capable to afford cosmetic surgery is also a factor, the doctor said, adding that global influence is playing a major factor in a woman's crave for the perfect body.

To go under the knife, Dr Okoro said the patient has to be healthy, must be an adult with realistic expectations and must have the financial means.

Sadly, he said, this crave has driven some people with limited funds towards a cheaper route of reconstructing themselves, with some grievous consequences. These cheaper routes have proven fatal for some people as they have lost their lives in the process, he lamented. According to the doctor, most people don't understand that there is a very thin line between professional plastic surgeons and cosmetic surgeon.

A young Nigerian woman was confirmed dead after a cosmetic surgery went awry in the United States of America.

Claudia Aderotimi, 20, developed chest pains and struggled for breath 12 hours after she had the illegal 'butt enhancement' silicone injections at a budget hotel. She was said to have been taken to a hospital but could not be saved.

"There is an increase in request for cosmetic plastic surgery in Nigeria. As the demand increases, it is very important that the public be aware of the dangers of undergoing plastic surgery by anybody representing themselves as cosmetic surgeon. There is a difference between a cosmetic surgeon and plastic surgeon," Dr Okoro said. According to him, his facility, launched in 2012, after 10 years of medical missions, due to pressure from colleagues and patients, operates on about two to four people per week.

The difference, he said, was in the certification.

The American Society for Aesthetic Plastic Surgery pointed out that plastic surgeons "are trained to perform surgery. It may sound obvious, but many people don't realise that only some of the 24 medical specialties recognised by The American Board of Medical Specialties include surgical training. Plastic surgery is a surgical specialty."

Dr Okoro added that board-certified plastic surgeons complete a minimum of five years of surgical training following medical school, including a plastic surgery residency programme. In-depth training encompasses surgical procedures of the face and the entire body. In his case, he said he spent eight years in training to become a plastic surgeon.

"Plastic surgeons are trained to prevent and, if necessary, handle emergencies. A comprehensive education, including a sound foundation in anatomy and physiology, provides plastic surgeons with an understanding of all body systems, including ventilation, circulation, fluid and electrolyte balance-which is vitally important to patient safety," the American Society for Aesthetic Plastic Surgery said.

Those in the field said because most people do not understand that cosmetic surgery is primarily focused on enhancing appearance through surgical and medical techniques, they tend to mistake it with plastic surgery which is dedicated to reconstruction of facial and body defects due to birth disorders, trauma, burns, and disease.

Plastic surgery is intended to correct dysfunctional areas of the body and is reconstructive in nature. The inadequate understanding of the two has led to some grievous consequences, an expert said.

They said it was advisable that those seeking aesthetic surgery approach plastic surgeon for the sakes of their health and general wellbeing.

The National Health Service, United Kingdom (UK), believes that today "an increasing number of cosmetic surgery procedures are performed in doctors' offices and free-standing surgical centres (as opposed to hospitals), and more procedures are being carried out simultaneously. This increases the risk of rare but potentially fatal infections and aesthetics reactions. Furthermore, some practitioners have not completed the full five years of residency training required for certification by the American Board of Plastic Surgery, but (legally) perform procedures, for which they might be inadequately trained, merely to augment their income."

This, experts said, explains the rise in complications which include but are not limited to infection, bleeding, fluid and salt imbalance, and allergic and aesthetic reactions which are sometimes fatal.

In Nigeria, Dr Okoro said three major popular and most done aesthetic surgeries included tummy tuck, liposuction and breast lift, otherwise known as breast augmentation. Modupe Ozolua went on record that her breasts were augmented. Women with small breasts have been known to enlarge them, while those with large breasts have had to have them reduced due to several factors.

But a school of thought insisted that with the advent of uplifting brassieres and corsets more women can enhance the sizes of their breasts, rather than going under the knife. Most men Nigerian Tribune spoke with said they preferred their women's breasts untouched surgically.

Still, women liberalists insist that it is the woman's body and she could do with it whatever she liked.

One of the major worries for plastic surgeons is that in developed world, the use of silicone breast implants is still very much rampant, despite the fact that the US Food and Drug Administration (FDA) had banned this procedure as far back as 1992 due to reports linking the implants with a variety of connective tissue diseases and neurological disorders.

Although there have been reports of "thorough analyses" which have shown no such links, Dr Emily Anderson, a plastic surgeon in the US, corroborated the NHS report which stated that "even so, breast augmentation with silicone implants is associated with a number of local adverse events, including hematoma, infection, scarring, contracture, rupture, pain, and loss of sensation."

Its statistics showed that "a minimum of 15 per cent of modern silicone implants will rupture between the third and tenth year after implantation."

African men will not be found on a cosmetic operating table seems to be the general consensus among the Nigerian male gender. Doctors say something different, however.

Dr Ayo Olaniyan, who works in Nigeria and California, said older Nigerian men often sneak in for a cosmetic surgery to combat the effects of aging, among other procedures.

With cosmetic phalloplasty and female reconstructive procedures touted as becoming popular, plastic surgeons in developing world have said the future of both cosmetics and reconstructive surgeries are becoming brighter. Yet, a very small group is asking if these procedures are actually worth the risk.

Take cosmetic phalloplasty for instance. This procedure is done to correct penile defects and is widely promoted to men who want to increase the size of their penises. The results were said to have been generally disappointing, as "size is only augmented for the flaccid state, and complications are common", according to NHS.

Then there are the female genital reconstructive procedures which include vaginal tightening, alteration of the vaginal angle, partial excision of "floppy" or "overgrown" vaginal labia, and the injection of fat into the labia to enhance plumpness, according to NHS. These procedures have been said to be dangerous and risky for the women who undergo them.