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Nutri-logics: Help for selecting a cosmetic surgeon

CARTHAGE, Mo. — Most females seem to resort to one of the four methods for choosing their surgeon for cosmetic surgery: articles from fashion magazines, finding out where celebrities went, getting a referral from a “friend of a friend,” and last but not least … checking out the doctors who advertise their services. Though these ideas may not be the absolute “worst,” they should only comprise the beginning of the search process, at best.

Take the time to get GOOD consumer information … draw up a comprehensive list of questions to ask so you’ll know your options; know which procedures will truly meet your needs, what are the risks and advantages, ad which doctors are performing the safest, most reliable and current procedures. The “latest” method may not always be the best method … I certainly wouldn’t want to be among the “guinea pigs” to help “gain practice” on a new technique!

Not shockingly, physicians tend to downplay the risks involved with most procedures. Before you decide on what to have done, please check the internet under “plastic surgeries gone bad …” At this point, you will know JUST HOW committed you are to the results desired!

Each and every surgical procedure has risks – anywhere from 1-5% of patients encounter some problems or a negative outcome. You must decide if it is worth the gamble of your being one of those statistical percentages. If the surgery goes bad in some way or produces less than idea results, the patient usually has to pay AGAIN to get it corrected. I can’t help, too, but wonder if those percentages are actually considerably higher than published BECAUSE why then do plastic surgeons make sure that every procedure is paid in full before patients go under the knife … curious, don’t you think?

Cosmetic vs. Plastic: the difference

What is the difference between a plastic surgeon and a board certified plastic surgeon? A lot! The issues here would be training and credentials … although a doctor may offer cosmetic, plastic or aesthetic surgery, he or she may not be board certified to perform that surgery. The person could literally be a dermatologist, pediatrician or gynecologist with no training in cosmetic surgery whatsoever. What “Board Certified” means is that the doctor has gone through a very specific and extensive training in a specialized field and passed different exams by aboard of experts in that field. Another “plus” about the Board Certified designation is that they are privileged to perform their craft at an accredited hospital. Even though it seems that most cosmetic surgeons perform procedures in their own offices, it’s good assurance to know that they have reached a skill level that commands working at the best facilities.

A non-Board Certified cosmetic or plastic surgeon may be self-taught and lack formal and extensive training in that field. It is completely fair to ask your doctor if they are board certified in plastic/reconstructive surgery.

Also, make sure to see if your doctor is a member of the ABPS (American Board of Plastic Surgeons). Check on the web to find out if he/she is board certified via http://www.plasticsurgery.org … can’t do any harm, right!? To be certified by the ABPS, a doctor must have at least five or six years of approved surgical training, inclusive of a two to three year residency in plastic surgery. They must also have been in practice for at least two years and pass comprehensive oral and written exams.

What to ASK?

Do your research homework, then feel free to fire away! Here are just a few examples of what to ask …

How many procedures of this type do you do in a given month?

How many surgeries do you routinely do in a day? If it is more than three watch out as the doctor you choose may not be starting and finishing the surgery … you pay him and want him from start to finish!

Make certain the doctor you consult with is truly the one doing your procedure all the way through – you don’t want him leaving or an “attending” taking over.

Ask the doctor if he charges for “re-do’s” and “touch-ups”… if he goofed, you shouldn’t have to pay!

Tips to Optimize Your Plastic Surgery Experience

Congratulations – you’ve finally decided to take the next step and proceed with cosmetic plastic surgery. While this is an exciting time for you, we understand that you may also have some anxiety about the coming weeks.

Here some techniques for you to follow in order to make certain that your plastic surgery experience will be successful as well as the recovery period.

From today until the morning of your surgery, use these tips to maximize your experience through careful planning.


To start of, find out how long your plastic surgery will take and also how long will you undergo the period of recovery. Schedule your plastic surgery during the time when you do not have any appointments to go to or some tasks that need to be done. Resting, relaxing, and unwinding as long as you can, are the chief techniques to have a fast and healthy recovery from the surgery. Stress will only add more time for recovery.

The amount of time needed for each cosmetic plastic surgery procedure is different. You have to fully understand first the amount of time needed for your recovery before deciding to go for it. Explain to your doctor your usual activities of daily living as well as if there are any future events that you will have to be preparing for.


You may prefer to call the assistance of your family or perhaps friends to help you out since nearly all plastic surgeries do not actually require bed rest. Regardless that you’ll only be going through a cosmetic surgery, it still is real surgery, and therefore needs careful planning.


Once you’ve decided on a cosmetic plastic surgery procedure, you must also decide how you will pay for it. Will you be obtaining financing, or have you had time to save for the procedure?

While plastic surgery costs are usually not covered by your regular medical insurance, there a number of ways you can pay for your chosen procedure.

Check with your plastic surgery center. Most centers will be able to offer you a variety of ways to cover the plastic surgery costs.

In addition to the cost of the surgery, you should also plan for small incidental expenses. If you don’t have adequate sick or vacation days stored at work, you may be required to take a few days without pay.

Being prepared will ensure your success with any cosmetic plastic surgery procedure you choose.

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A nip and tuck to get ahead

Once upon a time it was the domain of the greying generation trying to hang on to its youth. But a survey released this week has revealed one-fifth of working women admit they’d consider getting cosmetic surgery to further their career.

The poll of almost 500 female employees by The Heat Group also reported that 30 per cent of women have experienced discrimination at work based on their looks, highlighting a concern many feel to be true: good-looking people are more likely to get ahead.

In a study conducted by the University of California a few years ago, attractive staff members were found to earn more than their less attractive counterparts. The cause of this disparity was that beautiful people were perceived as being more helpful and cooperative than their peers, and less selfish, too. The scientists discovered this was true across various industries and societies.

Backing that research is another statistic from this week’s survey: 40 per cent of women know a female co-worker who has been hired or promoted due to physical attractiveness rather than job performance. Perhaps some of that result reflects a tendency for people to find something superficial to explain a rival’s success, but still, even if it’s only half right, it shows that meritocracy is somewhat absent.

One of the most prolific researchers on physical attractiveness is Dr Gordon Patzer. In his book, Looks: Why they matter more than you ever imagined, he cites studies showing that cuter babies are more likely to be held affectionately than those that aren’t so cute, and that teachers have higher expectations of the more attractive kids as they progress through school. So it’s not unusual to see the favourable treatment of attractive people spreading into the workplace, too.

Gillian Franklin, the managing director of Heat, told me the pressure on women to resort to cosmetic surgery as a career advancement strategy has been getting worse. “There is a heightened awareness today of cosmetic surgery which didn’t exist 20 years ago or even five years ago,” she said, adding that various procedures have become more accessible. “The general community is much more accepting of cosmetic surgery today and it’s more affordable now.”

In August, the International Society of Aesthetic Plastic Surgery released for the first time a compilation of worldwide comparisons. The United States came out on top as the country in which surgical and non-surgical procedures are conducted the most. This was followed by Brazil in second place, China in third, India in fourth, and Mexico in fifth. Australia is sitting at number 22.

The five most popular surgical procedures in Australia from highest to lowest are: blepharoplasty (removal of excess skin from the eyelids), rhinoplasty (nose job), breast augmentation (implants), breast lift (tightening up), and liposuction (removal of fat). And the most common non-surgical procedure was, unsurprisingly, botox.

Often it’s not just about the external gratification patients get from knowing people find them attractive. It also has a lot to do with how they personally feel about themselves. From a career perspective, if their self-esteem is up, they sound more assured in job interviews. When their confidence is stronger, they’re bolder during negotiations and salary reviews.

Official figures for work-inspired cosmetic surgery doesn’t exist here, but the American Academy of Facial Plastic and Reconstructive Surgery surveyed their members a couple of years ago. Two thirds of surgeons reported seeing an increase in cosmetic surgery among those who want to be more competitive in the workplace.

This isn’t just about women, either. Increasingly, blokes are going under the knife, too. But I wonder how many people are resorting to cosmetic surgery before exploring other avenues like their hairstyle, the clothes they wear, the food they eat, their skincare products, and their level of exercise. A surgically improved face might not compensate for deficiencies in those areas.

Regardless, a dud employee is a dud employee. Just because the packaging’s great doesn’t mean the product will deliver. It’s a shame there isn’t a surgical procedure to enhance the brain.


Web app allows you to preview cosmetic procedures on your cell or computer

Want a new nose? Chin reduction? Botox? A South Florida cosmetic surgeon has an app for that.

After the success of his iSurgeon app on Apple’s iTunes, Dr. Michael Salzhauer of Bal Harbour Plastic Surgery was approached by the United Kingdom’s version of MTV to create a similar program for its website.

Called “Heidi Yourself,” the new online tool lets users see what they’d look like if they changed their body or facial features. The name comes from MTV reality TV star Heidi Montag, who admits to having 10 plastic surgery procedures in a single day.

Heidi Yourself went live at the end of August and gets about 200 hits a day. And about half a million have downloaded Salzhauer’s free iSurgeon iPhone app since it launched last year, he said.

Salzhauer is among a handful of plastic surgeons using iPhone apps to promote their practice with a do-it-yourself-first photo editing tool. Toronto-based FaceTouchUp.com , which created morphing software for Salzhauer’s homepage, is building iPhone apps for plastic surgeons in Toronto and Beverly Hills and is slated to release more from doctors in California and New York in the next two months. In March, Dr. Elizabeth Kinsley of Covington, La., launched the iAugment app, designed to show a woman what it would look like to have larger breasts.

For Salzhauer and others, the interactive apps have become a new form of marketing. Out of the roughly 1,000 operations Salzhauer has done in the past year, about 50 clients mentioned they changed their images on the iPhone app before coming in.

“In this economy, it’s not like plastic surgery is on top of everyone’s mind,” Salzhauer said. Few who visit the MTV UK Heidi Yourself site may travel to see him, he said, but the exposure is worthwhile. And a few clients who downloaded iPhone versions have come from out of town to book his services.

“Cosmetic surgery has been hurt by the recession and it’s more of a luxury,” said Steve Ullmann, a healthcare management and economics professor at the University of Miami. “As more people can see what they are able to become … it can generate more business.”

Like prescription drugs advertisements and self-diagnosing websites such as WebMD.com , the iPhone apps give patients a sense of power.

“It’s knowing what you want to ask the doctor before you even walk in,” Ullmann said.

In the case of iSurgeon, that power comes with a light-hearted cosmetic surgery spin.

Like competing apps, iSurgeon requires users to upload a photo, preferably a profile shot of the area to be changed. A finger swipe or mouse click will stretch, shrink and lift parts of an image.

The iPhone app includes a timed game to see how quickly and accurately you can improve another patient’s nose, breast, tummy or butt. And with every nip and tuck on the app comes comical sound effects of moans, buzz saws and screams.

“I take my work seriously, but I don’t take myself too seriously,” Salzhauer said.

While some may use it for a cheap laugh, Salzhauer said he sometimes gets about 50 to 100 images sent to him daily from people who want to show him what they created on the app. A few months ago, about half of those were sent jokingly, but now 75 percent of the e-mailed photos he gets are taking the app seriously.

The technology to morph photos with a virtual makeover has been around for some time on the Web and in professional software like Adobe’s Photoshop, which can cost $500. But with the ease of a smartphone application, it only takes seconds to take a photo and begin editing it.

“Photoshop software is kind of complicated and expensive,” Salzhauer said. “This is free and instant.”

The free iAugment app by Louisiana’s Kinsley racked up about 100,000 downloads in the first month and now averages about 50,000 to 60,000 downloads a month.

“Those numbers are a lot greater than what I expected, and I think people think it’s a fun thing,” Kinsley said. “Plastic surgery can be very intimidating and it can be very intimidating to make that appointment.” The app serves as an icebreaker.

Kinsley said she’s been surprised at the number of plastic surgeons who have reached out to ask how they can make their own app — or be featured on her app. She charges an advertising fee for inclusion in the app’s “Find a Recommended Surgeon” feature.

“If you look at the cost of developing an app versus a YellowPages ad, it’s pretty close,” Kinsley said. “It’s a more 21st century way of marketing.”

Hisham Al-Shurafa, founder and CEO of Toronto-based FaceTouchUp.com, said he’s been getting requests to make apps for cosmetic surgeons in Florida, California and New York. The most popular feature after photo morphing: being able to see real patient before-and-after photos.

“They say it’s nice if a patient or potential patient can just open up their cellphone and show their photos,” Al-Shurafa said. “I’m pretty surprised now that we’ve been getting contacts from various corners of the country, from various doctors asking if we can build them an app. Typically doctors are late adopters when it comes to technology.”

The free version of Salzhauer’s iSurgeon puts the Bal Harbour Plastic Surgery name and contact information on the finished product photo, and encourages users to share edited photos on Facebook. But the paid version for $1.99 — purchased by about 7,000 — lets users save photos without the practice’s logo.

Hiring a programmer to create it cost Salzhauer about $10,000. “It was surprisingly affordable,” Salzhauer said, and he’s long since made his money back on it.

Although plastic surgery often raises concerns of negative body image messages, Salzhauer said the only complaints he’s heard are those who wish the software was more advanced.

The next step: building an application for the larger-screen iPad. But for Salzhauer, it’s a side project — not a priority.

“I think everybody is trying out new things to get through this economy,” he said.

The Five Telltale Signs of Poor Plastic Surgery

These days, it seems like everyone (and their mother) is getting a little nip ‘n tuck.

Changing your face can be a risky premise, and unless you’re careful about hiring only the most skilled board-certified cosmetic surgeon, you could be left with one of the telltale signs of having had “something done.”

Even celebrities aren’t immune to falling prey; bad work comes at every price point.

Below, you’ll find the top five most common — and glaringly obvious — signs that someone has had poor plastic surgery.

And if you’re shopping around for your own youth surgeon, be on the lookout for these signs in their before and after photos. If you spot any of them, it’s best to quickly move on to a consultation with another potential doctor.

The Nike Swoosh
In a carefully crafted facelift, a good surgeon will lift tissue upwards for a naturally lifted looked that encompasses the entire face. It takes experience and skill, and New York plastic surgeon Dr. Robert Freund says that less adept docs often try to cut corners by just stitching the skin towards the ears.

“A good face lift is a vertical orientation lift. The problem is, many plastic surgeons pull the skin horizontally. The patient ends up with a Nike swoop, more commonly referred to as a windblown look,” says Dr. Freund.

The Nike Swoosh — also known as a lateral sweep — occurs as the facelift ages. While the two stitched points near the midline and ear of the face remain lifted, the tissues in the middle hang and sag with age — resulting in that lower part of the swoosh.

The Pixie Ear: You’ll notice Dolly Parton always wears her hair down around her face to hide her ears, even when she’s wearing an updo. She’s admitted to getting a facelift on “Larry King Live.” Photos: Rick Diamond, Getty Images | Walter McBride, Retna
The Pixie Ear
In spite of the nickname, the pixie ear is anything but cute. It occurs when an unskilled surgeon cuts poorly during a facelift, and pulls the earlobe down to the face so that it becomes attached to the skin in a seamless angled line that no longer shows a separate earlobe, says Dallas, Texas plastic surgeon Dr. Sam T. Hamra.

The popular discount cosmetic surgery chain — Lifestyle Lift — churns out many pixie-eared patients who Dr. Freund says he has had to perform corrective surgery on. The plight is also common among mature silver screen stars who have had face lifts decades ago, when the side effect was even more common.

“I once had to correct a famous actress who had pixie ear on one side, but not the other. She had it done by the most famous surgeon in France. She would always insist that all of her movie scenes be shot on the one side without the pixie ear,” recalls Dr. Freund.

Ellen Pompeo and Janice Dickinson both have highly arched brows that look like they may have gotten botox. Photos: Mike Coppola, FilmMagic | Picture Perfect / Rex USA
The Cruella de Ville Botox Brow
The nicknames for this visual are endless — you’ll also commonly hear it referred to as the Joker, the Jack Nicholson, the Diablo Brow and the Mr. Spock Brown. All the clever jabs mean the same thing: you look like you’re permanently surprised.

“The unnaturally high arched lateral eyebrow is a dead giveaway of Botox. It usually occurs when Botox is injected in the wrong place, or not injected into the muscle that lifts the brow,” says Encino, California facial plastic surgeon Dr. Michael A. Persky.

Fortunately, the over-emphasized arch can usually be corrected by injecting a small amount of Botox into the forehead muscle directly above the brow to relax it, says Dr. Persky.

Less fortunately, by count of the high number of women who regularly sport the look, not everyone realizes that the look is unnatural. Some, like Janice Dickinson, even appear to seek it out.

The ‘Done” Nose Job
No where can the over-zealous pursuit of beauty end up more disfiguring than the nose, which can be extremely difficult to correct once the damage is done.

An expert nose job will gently erase what may be considered detractors from the face; things like bumps, humps and a too-prominent presence. But an obviously ‘done’ nose job will utilize unnatural pinching and nasal angles that just don’t occur in nature, says Dr. Persky.

In many situations, the final botched visual will occur after several surgeries have been attempted to placate the wants of someone who just isn’t satisfied with their nose. Such is the case with several members of the famous Jackson family, who are just as well-known for their cartoonish noses as they are their record-selling music.

Mickey Rourke has white scars behind his ear that suggest a Country Club Ear Scar. Photo: Lester Cohen, WireImage
The Country Club Ear Scar
The most common and difficult cosmetic surgery giveaway to hide, light white scars can often be seen in front of, under, and especially behind the ears.

“This is the big one, and you’ll see it all over the country club tennis-playing circles,” says Dr. Freund, who also adds that many women stop wearing ponytails after having a facelift that leaves them with scars.

The stubborn marks occur when surgeons pull the skin towards the ear to make it look taut, and then stitch it down. It’s a simple and quick technique to employ, but more often than not, does leave obvious scars.

“The right way to do a face lift is not just to pull skin — you’ll look good for three months, but then the skin will drop again and you’ll be left the same, but now with scars. The muscle should instead be repaired and an extra incision created under the chin so no one can see the mark,” says Dr. Freund.

Advances in reconstructive surgery

When Tommi Peterson was diagnosed with breast cancer in 2007, as a nurse, all she could think of was the patients she took care of in the 1970s – women who’d felt disfigured after having radical mastectomies to remove all of their breast muscle and tissue.

“I wasn’t aware of all the choices available to women today,” said Peterson of Burlington Township, N.J.

But Peterson learned that the treatment, surgeries and implants have all come a long way.

Up until the mid to late 1970s, most women had one or both breasts surgically removed to treat breast cancer. If they wanted their breasts reconstructed, patients had to be cancer-free for five years first, said Dr. Brian Buinewicz, chief of the division of plastic surgery at Abington Memorial Hospital.

Now, besides having the option of a lumpectomy to remove just the cancer, women can have a simultaneous mastectomy and reconstructive surgery. And surgeons can reconstruct a breast using implants or a person’s own tissue, Buinewicz said.

Laser Eyelid Lift

Droopy Eyelids

As we age, the skin loses some of its elasticity and begins to droop and sag. In some people, one of the areas where drooping is more pronounced is around the eyelids. The skin just above the eyes may sag, overlapping the upper eyelid. If the lower area is affected, the sagging creates small bulges under the eyes. Erik Happ, M.D., Ocular Plastic Surgeon with Allegheny General Hospital in Pittsburgh, PA, says that although droopy eyelids are most commonly associated with aging, the condition can sometimes occur in younger people, especially contact wearers or others who chronically pull and manipulate the skin around the eyes.

Droopy eyelids are often considered to be a cosmetic problem. The condition can make the eyes appear sleepy, tired or old. However, in some cases, the sagging tissue can encroach over the eye and obstruct the field of vision.

Fixing Droopy Upper Eyelids

The procedure to fix droopy eyelids is called blepharoplasty. To work on the upper eyelids, the surgeon usually makes an incision within the eye fold, running from the inside corner to just beyond the outside corner. Excess fat and skin are removed and the incision is closed with stitches. The sutures are typically absorbable, or removed after seven days.

After the surgery, a patient may have a significant amount of bruising, swelling, discomfort and sensitivity to light. Most of these symptoms ease within one to two weeks. Some risks associated with blepharoplasty include: hematoma, infection, scarring and eye dryness or irritation.

Blepharoplasty is the third most common cosmetic surgical procedure performed in the U.S. According to the American Society for Aesthetic Plastic Surgery, more than 149,940 procedures were performed in the U.S. in 2009.

Gynecomastia and its treatment

It’s not often the topic of discussion at dinner parties, but male breast reduction surgery is surprisingly common, according to the American Society for Aesthetic Plastic Surgery (ASAPS). Nearly 17,000 male breast reduction surgeries were performed in 2009.

Male breast reduction surgery is usually performed to treat gynecomastia, in which the breast tissue in men becomes enlarged. Obesity is another cause of breast enlargement in males.

Gynecomastia and its treatment
Gynecomastia is swelling of the breast tissue in boys or men, and it is triggered by a decline in the level of testosterone compared with estrogen. This decrease in hormone levels can be caused by natural hormone changes, the use of certain medications or drugs (e.g., anti-anxiety drugs, tricyclic antidepressants, AIDS medications, marijuana, heroin, among others) and certain health conditions, such as hypogonadism, tumors, and kidney and liver failure. The cause of gynecomastia is unknown in about one-quarter of cases, according to the Mayo Clinic.

Although gynecomastia is typically not a serious problem, it can cause breast tenderness and discomfort as well as emotional stress and embarrassment. In young males during puberty, gynecomastia usually goes away without treatment within six months to two or three years. The condition can peak again between the ages of 50 and 80, a time when it affects at least 25 percent of men.

Gynecomastia can be treated with medications that can balance hormone levels or by treating an underlying medical condition, although surgery is also an option. In fact, “male breast reduction is actually more common than one might think,” according to Felmont Eaves III, MD, president of the ASAPS.

Breast reduction surgery in men can help men feel more confident and comfortable with their appearance and avoid the social stigma of having large breasts. Dr. Eaves points out that most young men who have enlarged breasts should wait until they pass through puberty before having surgery for breast reduction.

Since 1997, there has been a 50 percent increase in the number of male breast reduction surgeries performed, according to the ASAPS. Nearly 60 percent of the surgeries were done on men ages 19 to 34.

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