First impressions count. They count so much, in fact, that Americans undergo roughly 15 million cosmetic procedures each year.

Dr. John A. White creates first impressions.

Or, at least, he helps improve them.

Best face forward

White is an otolaryngologist, a doctor who specializes in ear, nose and throat disorders.

“Years ago, (cosmetic surgery) used to all be done by general plastic surgeons,” White said. “Now, different specialties are breaking into plastic surgery.”

In his role of cosmetic surgeon, White focuses only on face and neck procedures. Common procedures include surgeries changing the appearance of ears, noses, facelifts, skin resurfacing and removing excess skin around eyelids.

When a patient comes in to ask about making a change, White talks with him him or her about desired effects.

But he never suggests changes.

“You can get into trouble making suggestions,” White said.

Asking someone how she wants to change her nose when she only wants to remove a mole can be an awkward mistake.

“It’s not so much our job to tell people what they need,” he said. “We always ask what they would like to change.”

After pinning down what a patient wants changed, White and the patient talk about potential procedures and time and cost limits. More and more, people are opting for minimally invasive procedures, such as Botox injections or collagen fillers, which take less time to heal.

“A lot of different technology is coming out,” White said. “You don’t have to undergo surgery to achieve the effect you’re looking for.”

A skilled hand

White first became interested in cosmetic surgery when he studied at Tulane University.

Two of his instructors were what he calls the “fathers of cosmetic surgery.” He eventually chose otolaryngology and cosmetic surgery, which was a good fit.

Transforming someone’s appearance takes dexterity and an eye for detail, White said.

“I’m a fanatic about detail,” White said. “You have to be that sort of individual when you do cosmetic work. I think anybody who does good cosmetic work has to be a bit of a perfectionist.”

Forever young

White foresees an increase in business in coming years. As baby boomers age, they want to remain vital and active, and they don’t want to look older, he said.

“Many of (the baby boomer generation) thinks of eternal youthfulness as their right,” White said. “I think that increase in a desire for cosmetic surgery will be a big boon to the industry.”

But the desire to transform one’s face isn’t limited to the baby boom generation. People in their 20s or early 30s will come to White to address concerns about skin growths or sun exposure.

Cosmetic procedures sometimes carry a stigma, White said.

“We’re so inundated by celebrities and movie stars, we tend to look at it as being overdone,” White said. “I think that influences a lot of people’s opinions, either positively or negatively.”

And, although White recognizes that some people might see cosmetic surgery as superficial, opinions change when it’s their faces in the mirror.

“Those people have to be careful because, who knows, in the next 10 or 15 years, they might have extra skin around their eyes they don’t think looks acceptable,” he said.

Under the light

Changes in technology mean plastic surgery isn’t the only way you can look better.

Lasers, lights and facial rejuvenation procedures can truly be “lunchtime procedures,” said Jennifer Mire of The Laser Clinic in Natchez.

Mire, who has her master’s of science in nursing, works under the supervision of her husband Dr. Blane Mire, who is a medical doctor.

Some of their procedures, like White’s, require the doctor’s hand, but others can be done in an hour by a trained technician.

One of their most commonly requested services is hair removal, Mire said. But The Laser Clinic, in the Doctor’s Pavilion, also offers treatments for spider veins, brown spots, acne and redness, among other things.

The clinic has been open approximately two and a half years, and business grows with time, she said.

The time is right for procedures that improve appearance, and technology is paving the way.

“People are living longer and philosophies have changed,” Mire said. “We really care about prevention from aging.

“If you look better you feel better. You do healthier things.”

Beyond beauty

Not everyone turns to cosmetic procedures to look more like their ideal though, White said. Some just want a chance to return to a normal life.

Some come for more serious reasons. A car wreck might have seriously scarred a woman’s face, or a man’s face could be genetically malformed.

One of the most rewarding experiences White has had was when he was teaching. Several patients came in with severely malformed ears.

“We would take cartilage from their rib and create a new ear for them,” White said.

Another high point was creating new noses for patients with leprosy whose noses had collapsed.

“When the challenges are the greatest, the results are the most gratifying,” White said.

A new you

Cosmetic surgery is one of the more painstaking surgeries, White said.

“Everything you do is out there and visible,” he said. “It’s not like removing a gallbladder. Everything is visible. And the first thing people focus on when they look at you is they look at your face.”

But that’s also one of the most rewarding parts about being a cosmetic surgeon, the visible results and the thanks.

The best changes are often subtle. A surgeon knows he’s done well when the patient says, ‘Something’s different, but I can’t put my finger on it,’ White said.

When surgery patients come in for a follow-up visit, White often finds that more than their faces have changed.

“They get a tremendous boost out of an improvement in how they look,” White said. “You get the biggest gratification when you see your patients are not only happy, but you see a change in their personality.”