Celebrity Cosmetic Surgery Red Carpet Secrets Revealed

With the Oscars upon us, that means one important thing for some of Hollywood’s hottest celebs: It’s time to sneak a trip to the cosmetic surgeon for a tune-up.

After all, millions of eyes and flashbulbs will capture their spins on the red carpet, and with it, any flaw that dares to bulge, spot or wrinkle on the world’s most glamorous stage.

We caught up with New York plastic surgeon Michelle Copeland for the 411 on what last-minute nips and tucks the celebs have been booking in the days leading up to the Oscars. “I don’t envy celebs, they’re scrutinized so much. Fortunately, there are a variety of nonsurgical ‘quick fixes’ that have no downtime that I can choose from to make them look good. Celebrities have always been at the forefront of using these kinds of treatments, because of the pressure to constantly look good for public appearances,” Copeland tells StyleList.

Ideally, patients come in a few weeks before the day to assess their concerns, and put together an action plan of what is often a variety of touch-up procedures to tighten skin and give it a glow. Yet with busy filming and travel schedules, it’s not uncommon for many celebs to wait until the last minute for their fix.

“They’re so busy, it slips their mind — and then suddenly, they look in the mirror a week before, and say, ‘I need to do something, now!'” Copeland says of her patients, some of whom have booked appointments just days before the Oscars.

So what kind of fixes are celebs clamoring for? Read on as we list the top most requested pick-me-ups.

Fat Shrinkage

When you’ve got to slip into a sexy body-baring gown, Spanx can only work so many miracles. In addition to supportive undergarments, celebs turn to the Zerona laser to shave off a few more inches of fat.

“Zerona uses light energy to help shrink fat cells. It’s not surgical, and not painful. You sit in front of a light for 45 minutes every other day for six sessions. Most people lose between 3.5 to five inches,” explains Copeland.

Patients often combine the Zerona with their already aggressive pre-Oscars routine combination of a light diet and exercise for best results.

Copeland says the fat is truly burned off, as it would disappear if you had exercised or dieted it away. Naturally, if you overindulge again and gain weight, the fat cells can come back as they otherwise would.

Sessions vary in cost, but can run between $500 to $700 per visit, with six treatments within a two-week time frame suggested for the maximum return on your investment.

With cost being no restriction for the wealthy, Copeland reveals that she just had a patient who doubled up on sessions, for 12 altogether, and lost a staggering 14 inches of fat total — which is an uncommonly exceptional result, even for celebrities.

Skin Tightening

Strapless and low-cut gowns may look simply stunning on the red carpet, but they also put a laser focus on areas where many women feel self-conscious about the pull of gravity: their jowls, the back of the arms and décolleté.

Thermage uses radio frequency waves to stimulate the tightening of the tissues. You’ll see immediate results, but the tightening effects will continue for three to six months,” says Copeland of the laser.

Another new laser that is “hot off the press” right now is Ulthera, which works in much the same way as Thermage. With no downtime and instant gratification from both lasers, they’re often used just days before the Oscars for tightening.

A common area that is zapped by both genders is the under-eye area, which can get puffy and loose with age — and of which high definition video is becoming increasingly unforgiving.

The widespread use of these lasers right before big events can also be attributed to a relaxed comfort level, since results look believable. The heat simply stimulates the natural collagen found in your skin.

This type of laser can vary dramatically in cost, as people may treat anything from a small area like the jowls to a more expansive area like the chest and back of arms. A typical cost can range from $2,000 to upward of $6,000 per individual treatment.

Brown Spots Begone

Pigmentation changes are one of the most common aging concerns, and celebs aren’t immune. Most say they’re especially self-conscious about spots on the face, cleavage and back of the hands while posing for their Oscar arrival photo.

Entirely eliminating brown spots takes multiple treatments or more invasive procedures like deep chemical peels that require downtime, and can’t be done merely days before a big event. Powerful lasers may zap problematic spots into oblivion, but they form a scab that must naturally flake off on its own, or else risk scarring.

However, a variety of noninvasive treatments like microdermabrasion and non-ablative lasers can be combined like a cocktail to significantly lighten spots in as little time as a week before the big day.

For maintenance, a regular patient may first go through the regimen of four to six sessions to undo sun damage on the skin, and then maintain with follow-up sessions once every season. Celebs, on the other hand, often book standing appointments every four to six weeks on regular rotation, so that their skin is always glowing.

“Celebrities don’t want highs and lows. They want to consistently look their best,” says Copeland.

The kind of non-ablative skin rejuvenations described above typically cost between $950 to $1,200 per individual treatment, with celebs stacking a few together for the fastest, most beautiful results right before an awards show.

Fillers and Botox

A mainstay on the red carpet for years now, Copeland says that fillers and Botox have unfairly been given a bad rap due to unskilled application and overuse.

“You can do it without ending up looking like Nicole Kidman or Meg Ryan. But not everyone is a Rembrandt! There are very different ways of applying Botox and fillers. Some ways give you natural animation, others make you appear frozen. It all has to do with the amount you use and the placement of it,” says Copeland.

Yet stars like Joan Rivers and Dolly Parton may actually want to look unnaturally taut.

Botox is a cosmetic must-have for most celebs. Photo: Win McNamee/Getty Images

“Some people actually prefer that artificial look and ask for it. People have different expectations for how tight and lifted they want their skin to look,” adds Copeland.

Fillers like Juvéderm and Restylane are most often shot into the lips for a fuller look, or to erase aging marionette lines. Radiesse is a firmer filler, and is often used in the cheeks for more support. While typical fillers last a few months, firmer versions like Radiesse can often stay in place for up to a year and a half.

Sold by the syringe, most patients require two syringes of filler for an area like deep laugh lines, or one syringe for the lips. Prices can vary dramatically depending on volume needed, and the part of the country the doctor practices. “It’s entirely possible to spend several thousand dollars on filler for the face,” says Copeland.

On the other hand, many surgeons sell Botox by the area of face treated — which is broken down into units — and can cost anywhere from a few hundred to a couple thousand dollars for a session.

But when it comes to Botox and fillers, celebrities have to be careful to treat themselves with at least a week to spare for healing, just in case they end up with surface bruising. Copeland says it’s difficult to anticipate whether or not a person will bruise.

“Sometimes people just bruise more than others. And sometimes they may be taking a blood thinner like Aspirin or Advil, and forget to stop them before coming in for an injection. That’ll make them bruise more. The good thing is, you can cover bruising with makeup,” says Copeland.

Ah, yes — that’s the magic of Hollywood.

Look better on your lunch hour

Thinking about plastic surgery? These procedures can help you look better without breaking the bank or putting you under the knife.

The Oscars are just around the corner, which means many Hollywood stars are getting nipped and tucked. But did you know you could make yourself “red carpet ready” without having to go under the knife?

“We sometimes call them ‘lunch hour procedures,’ ” says Dr. Douglas Sidle, a double board-certified Chicago plastic surgeon . “This means little bruising or recovery time, and a significantly lower cost.”

Want to suck the fat from your muffintop? Zeltiq could be just what you’re looking for. This relatively new nonsurgical procedure freezes fat cells in select areas for around $1,800 a treatment.

“You only need to go in once,” says Sidle. “People can read a book while they’re getting it done. This is very appealing because you don’t have to go under anesthesia, you aren’t spending thousands of dollars. But it isn’t pain free.”

Sidle says the results of a Zeltiq treatment aren’t as dramatic as the suction procedures—but the recovery time is shorter.

“People are worried about losing their jobs, so they aren’t racing to take time off to have cosmetic surgery,” he says. “The ideal candidate for Zeltiq is already in relatively good shape, but just can’t seem to get rid of those trouble spots.”

Sidle says because of the state of the economy, facelifts are being replaced by injections such as Dysport. Like its older cousin Botox, these injections temporarily paralyze the muscles, therefore reducing the appearance of lines or wrinkles.

“It’s so much faster to get an injection than to have a surgery,” he says. “Since Dysport came on the scene in 2009, it’s giving Botox some competition. In the last year, more and more people are choosing it over Botox because they want what’s new. They’re very similar, though. And you might be able to find Dysport for less because it’s trying to be competitive.”

Treatments cost between $300 and $800 depending on how many areas you inject, and can be done in ten minutes. But beware of clinics who offer Dysport at a significant discount. They may be diluting the product, which can mean you pay less up front, but have to go back sooner than expected.

“If properly injected by someone qualified, these treatments should last 3 months,” says Sidle.

Sidle says people are coming in for Dysport injections as early as in their 20s.

“It’s no longer people who have wrinkles that want to minimize their age lines—now I’m seeing women right out of law school who want to stop the wrinkles before they even start. You’ll see results within five days. It’s easy and fast, and that’s what people are looking for. And you can come in for a treatment and go right back to work.”

And men, don’t forget about Propecia—it’s not new, but this treatment for hair loss is effective, and it’s cheaper than ever.

“This is for men only,” says Sidle. “I recommend this to any of my male patients suffering from hair loss. Studies show 66 percent of patients can regrow hair, and while you still need a prescription for Propecia, it only costs $1.70 a day.”

Even though it’s easier than ever to “get some work done,” Sidle feels this in-and-out trend won’t last forever.

“I think once the economy gets better, more and more people will come back in for the traditional facelifts. I’m already seeing an increase in women getting rhinoplasty, or what many call ‘nose jobs’. It’s only a matter of time.”

Ethnic Differences Emerge in Plastic Surgery

  
An image showing different types of double-eyelid surgeries.

In Flushing, Queens, surgeons have their attention trained a few feet higher, on upturned noses that their Chinese patients want flipped down.  Russian women in Bay Ridge, Brooklyn, are having their breasts enlarged, while Koreans in Chinatown are having jaw lines slimmed.

As the demand for surgical enhancement explodes around the world, New York has developed a host of niche markets that allow the city’s many immigrants to get tucks and tweaks that are carefully tailored to their cultural preferences and ideals of beauty.  Just as they can find Lebanese grape leaves or bowls of Vietnamese pho that taste of home, immigrants can locate surgeons able to recreate the cleavage of Thalía, the Mexican singer, or the bright eyes of Lee Hyori, the Korean pop star. They can also find a growing number of doctors offering layaway plans to help them afford operations.  If the price is still too high, illegal surgery by unlicensed practitioners is available in many neighborhoods.  As these specialized clinics reshape Asian eyelids and Latina silhouettes, they provide a pore-level perspective on the aspirations and insecurities of immigrants in 21st-century New York — a mosaic portrait buffed with Botox.“When a patient comes in from a certain ethnic background and of a certain age, we know what they’re going to be looking for,” said Dr. Kaveh Alizadeh, . “We are sort of amateur sociologists. ”Dr. Alizadeh, himself an immigrant from Iran, admits that the results can seem less like science than like stereotyping.  Still, he and other doctors who work in ethnic communities say they can scan their appointment books and spot unmistakable trends:  Many Egyptians are getting face lifts.  Many Italians are reshaping their knees.  Dr. Alizadeh says his fellow Iranians favor nose jobs. And there is no questioning the surge in demand in immigrant neighborhoods, where Mandarin and Arabic are spoken in the operating room and patients range in age “from 18 to 80,” as one doctor put it.
About 750,000 Asians in the United States underwent cosmetic procedures, from surgery to less invasive work like Botox injections, in 2009 — roughly 5 percent of the Asian population, and more than double the number in 2000, according to projections by the American Society of Plastic Surgeons.  Among Latinos, the number was about 1.4 million, nearly 3 percent of that population and a threefold increase from nine years earlier. In 2009, about 4 percent of whites had cosmetic work done. In New York, new clinics have opened in immigrant enclaves, and existing practices have expanded to keep up with demand. The extreme makeover is, in many ways, a tradition among the city’s immigrants.
A century ago, in the early days of cosmetic surgery, European Jews underwent nose jobs and Irish immigrants had their ears pinned back in attempts to look “more American,” said Victoria Pitts-Taylor, a professor of sociology at Queens College who has written about popular attitudes toward plastic surgery. “The bulk of those operations were targeted at assimilation issues,” Ms. Pitts-Taylor said.Today, the motivations appear as varied and complex as the procedures.  Rather than striving to fit in to their new country, many immigrants reshape themselves to their home culture’s trends and tastes. “My patients are proud of looking Hispanic,” said Dr. Jeffrey S. Yager, who speaks Spanish and has tripled the size of his office since opening it in 1997 in Washington Heights, a largely Dominican neighborhood in Manhattan.  “I don’t get the patients who want to obscure their ethnicity.”While clinics that advertise in the local Russian, Spanish and Chinese media have much in common with one another and with those serving nonimmigrants — everyone wants a flat stomach and a smooth forehead — their core businesses are as different as the languages spoken by their patients.
Dr. Holly J. Berns, an anesthesiologist, feels as if she is on a seesaw when she travels from Dr. Yager’s office to suburban clinics.  On Long Island, she said, “they’re doing everything they can to get the fat taken out of their buttocks.”  In Washington Heights, “it’s the opposite — they just want their rear ends enlarged and rounded.”Italia Vigniero, 27, a Dominican patient of Dr. Yager’s, received breast implants in 2008 and is considering a buttocks lift to attain, as she called it, “the silhouette of a woman.”“We Latinas define ourselves with our bodies,” she said. “We always have curves. ”My personality doesn’t go with small breasts,” she added. Using the words “pecho” and “personalidad” — Spanish for “breast” and “personality” — she coined a term that could serve as Dr. Yager’s motto: “Now, I’m a person with a lot of ‘pechonalidad!’ ”
 
In Flushing, home to a vibrant Asian community with many recent immigrants, Dr. Steve Lee, a native of Taiwan, performs some procedures that are rarely, if ever, done in Dr. Yager’s clinic.  Some Chinese, he said, believe that prominent earlobes are auspicious, so Dr. Lee was not surprised when a male client asked him to inject a cosmetic filler into his earlobes to make them longer.“The bigger the earlobes, the more prosperous you are,” said Dr. Jerry W. Chang, another plastic surgeon in Flushing who understood the impulse. Other patients request that an upturned nose be turned “all the way down,” in keeping with a traditional belief that prominent nostrils allow fortune to spill out, Dr. Lee said.
Perhaps the most sought-after procedure among Asians is “double-eyelid surgery,” which creates a crease in the eyelid that can make the eye look rounder. Some people criticize the operation, which is hugely popular in many Asian countries, as a throwback to medical procedures meant to obscure ethnic features. “You want to be part of the acceptable culture and the acceptable ethnicity, so you want to look more Westernized,” said Margaret M. Chin, a professor of sociology at Hunter College who specializes in Asian immigrant culture. “I feel sad that they feel like they have to do this. ”During consultations before surgery, Dr. Lee shows patients a slide show of a white woman with a natural crease in her eyelids and Asian women without it.  He discusses the techniques — a stitch here, a cut there — that can bridge the anatomical differences.  But he, like several other Asian plastic surgeons, said the procedure had little to do with assimilation. “One of the traits of beauty is to have large eyes,” Dr. Lee said, “and to get that effect you have to have the double eyelids.”
For all the cultural differences, New York plastic surgeons acknowledge that ethnic neighborhoods are not islands. American pop culture, they say, has strongly influenced how immigrants and their children believe they should look, and reality television shows like “Bridalplasty” have encouraged surgical solutions. In Bay Ridge, Brooklyn, Dr. Elena Ocher, a Russian immigrant, attributes the wave of young Russian women requesting breast implants — by far her clinic’s most popular procedure among that group — to American culture, not Russian. “The new generations of Russians are very American, and there’s something in America about large breasts,” she said. “What is this fixation?”Maya Bronfman, 30, an accountant from Moldova, said many of her Russian friends had undergone procedures, but she shrugged off notions of American beauty ideals. “Everyone in New York is some sort of an immigrant,” she said. “They’re just doing it to feel good.” Dr. Ocher said that about 90 percent of her Russian patients seek operations on the body. But among her Arab clients, the vast majority want surgery on the face. “Arab people never completely expose any body parts,” she explained.Iranian and Italian women sign up for an array of procedures, from the face to the feet, Dr. Ocher said.  She has noticed that Italians tend to care more about their knees.“The knees should look young,” she said. “Italian girls wear a lot of miniskirts.”

10 Cosmetic Plastic Surgery Predicitions for 2011

 The American Society for Aesthetic Plastic Surgery (ASAPS), the leading national organization of board-certified plastic surgeons who specialize in cosmetic surgery, offers its predictions for cosmetic surgery in 2011. Predictions are based on interviews with leading plastic surgeons throughout the country, who are actively involved in cutting-edge surgical and nonsurgical aesthetic/cosmetic technology.

  1. As the economy continues to improve, demand for face lifts and other facial rejuvenation surgery will increase. Nonsurgical facial rejuvenation procedures will also see some growth, but people who have been putting off surgery for the past few years because of the economy will be ready for the gold standard in facial rejuvenation in 2011.
  2. The growth and popularity of cosmetic injectables (Botox, Dysport, Sculptra, Radiesse, Evolence, Juvederm, Restylane, Perlane etc.) will continue to increase as products continue to evolve and new players enter the market.
  3. As the population increasingly realizes the dangers and health consequences of obesity, the number of patients seeking plastic surgery procedures for body contouring after dramatic weight loss (abdominoplasty, lower body lift, upper arm lift, etc.) will rise in 2011.
  4. As the baby boomer generation continues to age, so do their breast implants. This year, many baby boomer women who have aging implants and/or breast ptosis will replace their implants and have breast lifts.
  5. Consumers looking for a bargain on cosmetic procedures will unfortunately lead to an increase in horror stories about “discount injectables” bought offshore, and cosmetic medicine and cosmetic surgical procedures performed by untrained or poorly trained practitioners.
  6. Although liposuction (lipoplasty) will continue to be the gold standard in fat reduction, there will be continued interest in experimental techniques for noninvasive fat removal (freezing, zapping, lasering, etc.) as a future alternative or adjunct to liposuction (lipoplasty) surgery.
  7. Aesthetic medicine has seen a dramatic increase in the diversity of the patients treated during the past decade, and this trend is expected to continue to grow stronger than ever, with applications that cater to all people. The appeal of both aesthetic surgery and cosmetic medicine will continue to spread across the spectrum of our population, as plastic surgeons further tailor treatments to meet the sometimes unique needs of that expanding population.
  8. As the popularity of nonsurgical and minimally invasive procedures continues to grow, surgeons and manufacturers will develop new techniques and products that advance the science, produce even better results and lessen recovery time.
  9. Celebrities such as Kim Kardashian, Beyonce and Jennifer Lopez have made a shapely rear-end a must have accessory. In the coming year patients will be seeking posterior body lifts, buttock lifts, surgical and nonsurgical buttock augmentations to shape and augment their buttocks.
  10. Following the trend in increased consumer sophistication patients will increasingly want to know if the latest procedure and device being touted on the internet and TV talk show really works and if it is safe. By incorporating evidence-based medicine into the core specialties of plastic surgery, it will be easier for both doctors and patients to determine fact from fiction.

Costs are comparable for face transplant vs. multiple reconstructions

Face transplantation — at least in the near-term — may not cost much more than the multiple conventional reconstructive surgeries that a complex case would need, according to the team that did the first U.S. face transplant.

That near-total face transplant done in 2008 for a woman injured by a shotgun blast cost $349,959 compared with $353,480 for the 23 separate conventional reconstructions she had done before transplantation.

The post-transplant costs added an extra $115,463, but the overall cost was “similar,” Maria Siemionow, MD, PhD, DSc, the reconstructive surgeon who led the transplant team at the Cleveland Clinic.

Moreover, the piecemeal reconstructions hadn’t offered good results, Siemionow and colleagues reported online in the American Journal of Transplantation.

“Although the cost of facial transplantation is considerable, the alleviation of psychological and physiological suffering, exceptional functional recovery, and fulfillment of long-lasting hope for social reintegration may be priceless,” the group wrote.

The 46-year-old woman had lost her nose and palate in the injury and had been unable to breathe, smell, taste, or eat normally. She remained so disfigured that she reportedly wouldn’t go out in public despite four years of reconstructive surgeries.

The transplant from a dead donor replaced 80% of her face, including the cheeks, lower eyelids, nose, and upper lip as well as cheek and maxillary bone and some upper teeth.

The world’s first partial facial transplant had been done in France in 2005 for a dog attack victim. The success of the French and U.S. cases spurred further facial transplantations, including the world’s first total face transplant in Spain in 2010.

Siemionow’s group had called for consideration of face transplantation as first-line treatment for severe facial trauma.

But, they noted in the journal article, “As face transplantation moves further away from the questions of ‘can we?’ or ‘should we?’, the question of fiscal responsibility will soon move into the forefront and may likely become the central issue of the face transplant debate.”

To address that issue, Siemionow and colleagues detailed the costs for their case.

Inpatient costs were estimated to be 25.5% higher than for the conventional reconstructions the patient had prior to transplant.

The biggest components were surgical costs — 42% for the face transplant and 38.5% for the conventional reconstructions — and nursing costs, 19.7% for the transplant versus 27% for the conventional surgeries.

Pharmacy costs, though, were doubled with face transplantation at $38,574 (16.6% of total costs) compared with $16,581 (8% of total) for reconstruction.

Immunosuppression — required to prevent graft rejection — was the major reason for the difference at a total direct cost of $21,506 for the regimen of antithymocyte immunoglobulin, granulocyte stimulating factor, tacrolimus, mycophenolate mofetil, and steroids for varying durations.

However, these cost comparisons include only the early period, the researchers noted.

Chronic immunosuppression for other transplant types ranges from $10,000 to $20,000 a year, so life-long immunosuppression for the face transplant patient could add up to $370,000 to $518,000.

Although long-term immunosuppression carries risks, the consequences of facial graft failure remain unknown.

Other organs like the kidney can be removed and the patient temporized until retransplantation, but what reconstructive options exist and the possible morbidity and mortality aren’t clear for face transplant, the Cleveland Clinic team acknowledged.

The single-patient case study findings may not generalize to other patients, institutions, or countries, and objective cost comparisons couldn’t be done, making the cost conclusions only speculative, the researchers warned.

But the financial considerations don’t tell the whole story, they added.

“Given the face’s … role in societal acceptance, it is impossible to truly quantify the value of this procedure using monetary means as it has immensely improved our patient’s overall quality of life, thus leading to significant reductions in both psychological and physiological anguish,” they concluded in the paper.

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Leeches are making a comeback as medical helpers

Worms help preserve tissue by aiding blood flow.
Marc Miller survived a motorcycle crash in October near his Baltimore County home, but his foot had been dragged along the pavement and badly damaged. That injury would require both the most advanced medicine and an ancient therapy — leeches.

Trauma doctors at Johns Hopkins, the University of Maryland and other U.S. hospitals routinely use leeches as a temporary measure to keep blood flowing as new vessels grow in a damaged area. The animals kept blood moving in and out of a new skin flap sewn onto Miller’s foot. They also can get blood flowing to amputated digits that are reattached. And because the leeches’ saliva has a natural anesthetic, some doctors now are looking to use them to ease pain.

“They can be the difference in whether the tissue lives or dies,” Dr. Scott D. Lifchez, who treated Miller and is section chief of plastic surgery at Johns Hopkins Bayview Medical Center, said about the blood-sucking worms.

The U.S. Food and Drug Administration gave its approval to market leeches as medical devices in 2004, though they had been used for many years before then. And their use appears to be growing, said Dr. Ronald A. Sherman, director of the BioTherapeutics, Education and Research Foundation, which supports the medical use of leeches and other furry, slimy and microscopic animals.

Guide dogs may be the best-known in the category, said Sherman. But others, particularly leeches and maggots that clean wounds, are gaining in popularity. Maggots are used more than 50,000 times a year worldwide, he said.

As for the use of leeches, Sherman said there is no registry or certification board for physicians in the United States, so no one can say how often they are used for medical purposes. At an annual conference hosted by his group, seminars on leeches drew 100 medical professionals last year, more than any other year.

“In other countries, use of leeches has been ongoing for centuries, but in the United States, I would call it a comeback,” said Sherman, a retired University of California researcher. “The introduction of leeches for draining blood occurred in the late 1970s, maybe early ’80s, but my perception is that it’s getting more known.”

Records of the use of leeches in medical treatment stretch back many centuries — to a painting in an Egyptian tomb around 1500 BC, according to one study in a medical journal. Bloodletting therapies were popular in Europe during the 17th and 18th centuries, triggering shortages of the animals in some countries. Later, as medical science advanced and bacteria became the focus of treatment, the use of leeches faded. But in the 1970’s, their use was revived in microsurgery, the study noted.

Sherman said the primary use today is draining congested blood in damaged appendages or skin flaps. The leeches have a natural anticoagulant that breaks up small clots and keeps new ones from forming. That allows pools of blood to drain and keeps blood flowing freely until new vessels connect.

Doctors direct the blood-suckers to a specific site — Dr. Lifchez uses Vaseline and gauze to nudge them into place. They draw blood for about 15 minutes and fall off once they are full.

The alternative might be losing the appendage or having a more complicated surgery, said Sherman, who also notes the leeches are relatively inexpensive — Carolina Biological Supply Co., one of two U.S. suppliers, sells a 2-to-4-inch leech, Hirudo medicinalis, for $19.50. (Includes instructions. Sold only to schools and businesses, company marketing materials say.) Leeches USA Ltd. sells them for under $10 when purchased in bulk. The companies do not release sales information.

At Maryland Shock Trauma Center, where many of the worst accidents and injuries in the region are treated, leeches are employed several times a year, said Caroline Connolly, a veteran nurse who works with them.

She said the leeches have been around for about 15 years and are used when blood isn’t circulating well after a “free tissue transfer” — when a flap of skin, and possibly muscle, fat, vessels and even bone are moved from one part of the body to replace what was lost in the wounded area.

Even though these are medical leeches, grown in sterile environments, many patients are still “a little grossed out,” said Connolly. She said she only needs to tell the patients how successful the leeches are.

And the alternative is another long and complicated surgery to try another skin flap or amputation of damaged extremities. Connolly said leeches have been used to help rebuild faces blown apart by gunfire, but mostly they are used for car and motorcycle accident victims, such as Miller.

Lifchez used a leech every six to 12 hours on Miller over several days while he was in the intensive-care unit. There, nurses could watch over him and the animals. Miller said sometimes he’d alert the staff when a leech was done feeding so it could be properly disposed of.

Circulation problems arise in up to a quarter of cases of free tissue transfer, and the wound can benefit from leeches, Lifchez said.

It was a day or so after Miller’s 10-hour operation in October to place the new skin flap — which included some fat and vessels — when it began to look a little purplish.

Lifchez and another surgeon checked to make sure the sutures weren’t too tight and the vessel connections were properly done. But still the blood wasn’t flowing properly. They did not want to lose the foot, a likely prospect just a couple of decades ago.

The leeches arrived by overnight delivery.

Faced with amputation or more surgery, most patients are receptive to being treated with leeches, Lifchez says. Miller, who had once wanted to be a veterinarian, and his mother, Delores Williams, who is a nurse, both knew about leeches’ abilities and didn’t need any convincing.

“I remembered what leeches were capable of doing,” said Miller, who expects to shed his wheelchair and crutches in the spring and begin the process of relearning to walk. “I feel fortunate to have my foot. I feel very positive now.”

Lifchez said circulation is normal in Miller’s skin now. He may need another procedure to remove some fat transferred with the skin, making his foot bulge a bit. That would make it easier for his foot to fit in a shoe.

For now, Miller will remain at home supervised by his mother, who is thankful for the Hopkins team that saved her son’s foot — and for Miller’s declaration that his motorcycle days over.

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