Dr. Carolyn Chang’s patients don’t look like they’ve gone under the knife. The Stanford-trained plastic surgeon specializes in female patients who flock to her modern Pacific Heights perch because she knows what women really want. Unlike many of her counterparts, for example, Chang steers women away from breast implants that are so pronounced, they defy gravity. Her minimalist aesthetic draws candidates you’d never expect to her operating table, even in a city as antiplastic as ours. Chang, who was recently named vice chair of the department of plastic surgery at California Pacific Medical Center, tells us why Bay Area moms are opting for surgery, what they’re having done, and which cosmetic procedures actually have medical benefits.
2100 Webster St., Ste. 506, S.F., 415-923-3067, www.womensplasticsurgery.com.

Are some plastic surgery procedures beneficial to moms beyond their cosmetic value?
Yes. When the abdominal muscles have separated due to pregnancy, especially multiple pregnancies, we do an abdominoplasty (tummy tuck). Part of this process involves tying the muscles of the stomach back together, increasing stability, enabling better posture, and decreasing back pain.

Do many local moms have that done?
Lots! Especially here, where women have children so much later in life and use in vitro fertilization, which often results in twins or triplets. Multiples take a much greater toll on the body. Also, as women age, their skin typically loses its elasticity and is less able to bounce back to its prepregnancy state as quickly as with younger women. Most opt for some combination of breast and tummy procedures. Moms are busy. How long is the rehabilitation time for breast and tummy work? Recovery time varies according to the amount of surgery. But I usually tell mothers that they should have reliable help for at least a week after they return home, and they may not be feeling 100 percent for three to six weeks.

What other types of plastic surgery are moms getting?
A postpregnancy rule of thumb is that the places where your body collected fat before you had a child will be the places where it will collect again, but to an even greater degree. Moms commonly opt for surgeries to reduce love handles, fix the uneven or asymmetrical scars left by C-sections, and remedy droopy breasts.

What sort of work do moms have done on their breasts?
Whether you breast-feed or not, breasts engorge from hormones during pregnancy, and afterward they droop and fall. Most of my moms aren’t interested in going big. They just want to be fuller and less droopy.

Who gets the majority of boob jobs in this town?
Most of my patients are not stereotypical young women. For example, one was an Ironman triathlete who got a breast lift to improve her times. She thinks that eliminating some of the extra weight and laxity in her tissues improved her performance.

The FDA recently approved silicone implants for use in the United States after a 14-year ban. What is the difference between silicone and saline implants?
Silicone often looks and feels more natural than saline because it’s a gel. The greater viscosity of the silicone gel more closely resembles the feel of breast tissue and is less likely to cause visible ripples. I find that more breast augmentation candidates are opting for silicone. They need to understand, however, that silicone has a higher incidence of certain side effects, such as hardening of the implants, called capsular contracture, and may require more vigilant monitoring. But these implants have been approved by the FDA.

Can you tell that a woman has had a boob job from a mile away?
If her breasts are too tight, too high, or encapsulated with scar tissue that has thickened and contracted, you can tell that the person has implants. But you shouldn’t be able to. My silicone and saline implants look very soft, and they’re never too high. Patients feel comfortable having surgery with me because they know that they will get a completely natural result. They will not look “done” after the procedure.

How do you achieve an overall natural result?
We do more minimal surgery today than we used to. For example, if you have your eyelids done, we don’t remove all the fat. Someone I’ve done surgery on should just look prettier. She doesn’t necessarily look younger, and she doesn’t look “pulled”: there is still some wrinkle. Back in the day, the average facelift patient used to be in her late 50s or early 60s, and she would have every single thing done—a major overhaul. I am seeing younger and younger patients—late 30s, early 40s—doing it in stages. They are getting facial procedures as maintenance, as opposed to the usual lipo or augmentations most common in this age range. You can ease into age by correcting small things earlier.

Besides all the moms, who is getting plastic surgery?
It’s not just your typical wealthy lady of leisure! I did a full facelift on a professional rock climber who never wears makeup but is constantly exposed to the elements, which cause her face to more rapidly age and wrinkle. I did eyelids on a female military officer in her early 40s while she was on furlough from her deployment in Iraq. I did an upper lid blepharoplasty (an eyelid lift) and an endoscopic browlift (a less invasive browlift) on a female parole officer in her late 30s, because she wanted to look better on the job and her eyes constantly felt tired.

How does plastic surgery help tired eyes?
Many patients complain that their eyes feel tired and heavy, particularly at the end of the day. Eyelid surgery and browlifts can alleviate these symptoms and can improve vision.