Surgery and gem items permanent?

Are the surgeries (ex: +1 Constitution) from the healers permanent? There is no statement about that.
And the stuff payable for gems is permanent as well? (ex this +30 Max Energy stuff). And have that stuff to be equipped or is it working automatically after paying?
And the stuff payable for gems is permanent as well? (ex this +30 Max Energy stuff). And have that stuff to be equipped or is it working automatically after paying?