Patients seek breast augmentation, wrinkle relaxers, surgeons say

Reported by: Jaime Hayden Email:

News 4 looked at what neighbors in northern Nevada are turning to plastic surgery to change. “The typical patient that comes in to see me has been thinking about whatever procedure they’re coming to see me about for years,” said plastic surgeon Dr. Joseph Kiener.

Kiener sees around 15 new patients a week and 80 percent of his surgeries are cosmetic. “People, their motivation is typically that they don’t like something about themselves, and fortunately in my practice most the time it’s the patient that is motivating themselves to come here as opposed to a significant other.”

That is exactly why 60-year-old Janet Baron of Reno said she got a facelift three years ago. “I was taking care of my parents, I had a horrible marriage for 10 years, and I wanted to do something for me.”

Baron said she did not like the extra skin under her chin, but it was more than just changing her face. “I feel better, it’s almost like a new me.”

Now, she said strangers often think her 31-year-old son could be her husband. “Okay that’s kind of cool, he’s really upset, he goes that’s gross, but I go, you have to understand that makes me feel good.”

Although Baron said the selfie phenomenon did not affect her decision to go under the knife. Kiener said social media is playing a role for many, including opting for non-surgical procedures. “Things like Botox, the fillers, laser hair removal, as well as other laser and light based treatments.”

Still, Reno plastic surgeon Dr. Phillip Dahan said the number one cosmetic surgery on women’s wish list is breast augmentation. “The majority undergo breast implant surgery, such as augmentation to enhance the size, shape, projection of the breasts, and even to improve two breasts that don’t match, so to improve symmetry.”

Dahan said Botox, fillers, nose jobs and pec implants are popular options for guys, but men still only represent 10-percent of his plastic surgery patients. “Every now and then I have males that are very concerned that they try to exercise and improve the bulk and tone of the chest muscles and they can’t or they want to take it to another level, so it’s a great operation to do it.”

Kiener said he sometimes has to say no, but it is not easy. “You also have to be the patients advocate and say to them, ‘Well, I don’t think this is a good idea for you,” now the problem with that is that they’re so motivated that you know they’re going to go down to street and see somebody else, so where do you draw the line and that is a very difficult thing to do.”

Kiener said over the last two years he has seen the biggest increase in butt surgery. He also said plastic surgery is most popular among women ages 35 to 50, followed by women ages 50 to 65, and then women between ages 20 and 35.

A plastic surgeon weighs in on the changing faces of celebs

“Who’s that girl?”

That’s the question many were asking when a woman with Renée Zellweger’s toned body and sleek dress sense — but not her familiar face — posed on the red carpet with the actress’ boyfriend of two years. Turns out it was Zellweger on Doyle Bramhall’s arm — only instead of her trademark deep-set eyes and smirky grin, the 45-year-old actress had wide saucers and an eerily smooth complexion.

Zellweger is the latest example of a disturbing trend: women — and occasionally men — in the public eye who, in the process of “refreshing” or “maintaining” their appearance, go a few millimeters too far and erase or minimize the very features that made them famous in the first place. The result? A generic, fabricated Hollywood look that has sadly become all too common.

“Surgeons are always well-intentioned, but sometimes they’re a little bit too formulaic in the procedures they use,” said Dr. David Hidalgo, a New York-based plastic surgeon. “It’s not so much that it’s overdone, it’s just not individualized. For surgeons, it’s almost [more] important to decide what not to do than what to do. And that comes with experience.”

In an exclusive statement sent to People magazine, Zellweger dismissed suggestions she’d had work done as “silly” and attributed her highly alert appearance to being in love and enjoying a healthier lifestyle. “I’m glad folks think I look different!” she wrote. “I’m living a different, happy, more fulfilling life, and I’m thrilled that perhaps it shows.”

There is an art to looking “well-rested,” and top surgeons proceed with caution. Dr. Timothy Marten, a San Francisco-based plastic surgeon, notes that “certain areas of the face — in particular the eyes and lips — are known as loci of identity.” In other words, mess too heavily with these parts, and you just might wind up unrecognizable.

According to Marten, traditional eyelid surgery involves removing tissue that “can change the look of the eyes.” With lips, “there’s a tendency with famous faces to overfill the upper lip, and it looks unnatural” — when it should be the other way around.

Here’s a look at Zellweger and other stars remarkably transformed over the years.

Renée Zellweger

Renée Zellweger in 2011 and 2014.Photo: From left: Mike Coppola/Getty Images, Jon Kopaloff/FilmMagic

“She’s a beautiful and talented woman who may or may not have had a facelift,” says Dr. Timothy Marten. “She had a very full upper and lower eyelid and part of the reason she looks different is her eyelids no longer have that full, girlish look we all loved about her. It’s also possible something was done to her lips.” Her face has perhaps lost some of its softness, he noted. “She may have either lost weight or had facial liposuction or radio frequency or ultrasound,” he says, referring to skin-shrinking techniques that can result in the loss of facial fat.

Tatum O’Neal

Tatum O’Neal in 2009 and 2014.Photo: From left: Duffy-Marie Arnoult/, Gregg DeGuire/WireImage

The youngest person ever to win a competitive Academy Award is now 50 and likely fighting the hands of time with injections, not surgery. “It’s all about fat transfer or filler,” says New York-based Dr. David Rosenberg, adding that the substances dissolve so the pillowy effect will wear off.

Kenny Rogers

Kenny Rogers in 2000 and 2014.Photo: Right: Rick Diamond/Getty Images

The singer-songwriter and actor is a wide-eyed and bushy-tailed 76. “It looks like he had his eyes done and possibly a brow lift,” says Dr. David Hidalgo. “It has totally changed his appearance. It doesn’t look like he’s had a facelift because of his neck.” Does he look better? “It’s safe to say that he looks cleaner but he looks different.”

Olivia Newton-John

Olivia Newton-John in 2005 and 2014.Photo: From left: Eric Neitzel/, Bim/Broadimage

We’re hopelessly devoted to the “Grease” star and singer, even if she’s done the lift and fill. “To have a neck like that in your sixties, you’ve had a facelift,” noted Dr. David Rosenberg, adding that she’s probably had some filler or fat transfer and put on a few pounds. “She’s looking beautiful. She looks better than when she was 30 years old.”

Winona Ryder

Winona Ryder in 2005 and 2014.Photo: From left: Steve Granitz/, Bruce Glikas/FilmMagic

Her first major role was as a goth teen in “Beetlejuice,” and while she could no longer pass as a high school student, grad school would not be a stretch. Dr. Rosenberg does not believe the gorgeous 42-year-old actress has had a facelift or her eyes done. “She looks thinner and it doesn’t look surgical. It looks like she has maybe some fillers in her cheeks. You can see the pads under her eyes.”

Plastic surgery helps patients complete transformation after weight loss

Sue Thoms | By Sue Thoms | sthoms1@mlive.comThe Grand Rapids Press on September 29, 2014 at 7:00 AM, updated September 29, 2014 at 11:07

GRAND RAPIDS, MI – When Dr. Ryan Mitchell was in his plastic surgery residency, he developed an interest in a growing area of practice – body contouring for patients who have sustained a major weight loss.

The surgery to remove the excess skin left behind is becoming more in demand, as obesity rates rise and bariatric surgery becomes more common, he said.

Mitchell, who recently joined the Bengtson Center in Grand Rapids, pursued a fellowship to specialize in the treatment.

“It became my passion,” he said.

His draw to the specialty is the chance to address quality-of-life and physical needs of the patient. Many of the patients he has met, although they have lost in the range of 100 pounds and are much healthier, experience a bit of “buyer’s remorse,” he said.

Bengtson before and after.jpgBefore after photos show a patient of Dr. Bradley Bengtson after body contouring surgery. Dr. Ryan Mitchell, a surgery specializing in body contouring after major weight loss, recently joined Bengtson’s practice.

Even with diet and exercise, they can’t lose the excess, sagging skin.

“People have said I look worse now than I did before. One patient said when she was larger, she was just the largest person on the beach. Now when she goes to the beach, she feels she gets looks and attention because she doesn’t fit into either mold,” he said.

Body contouring procedures often target the belly, arms, legs and buttocks area.

The problems caused by excess skin are not all cosmetic. There also are functional problems, particularly with the skin around the belly. That area is prone to rashes and infection. And for some patients, the excess skin on the thigh prevents them from wearing slacks.

While health insurance sometimes covers removal of the overhanging skin on the abdomen, patients usually must pay out of pocket for contouring procedures on other parts of the body.

Mitchell said the cost of surgery varies depending on a number of factors. But as a general range, the cost to patients can run from $14,000-$16,000 for abdominal surgery and $6,000-8,000 for arms, including surgical and hospital fees.

A dual U.S-Canadian citizen, Mitchell received his medical degree in plastic surgery from the University of Manitoba. He did his fellowship in body contouring and reconstructive surgery at the University of Pittsburgh Medical Center.

To undergo body contouring surgery, patients must meet certain criteria, Mitchell said.

“They have to be weight stable for about 12 months,” he said. “In some of them, their weight tends to fluctuate. Once they have reached their plateau, that’s when they are optimized for surgery.”

Because some post-bariatric patients are at risk of malnourishment, patients must be on a high-protein diet to improve wound healing, he added.

He cautions patients that there will be scars. He can often hide abdominal scars in the area that would be covered by undergarments or bathing suits, but scars can’t be hidden on upper and lower extremities.

“Almost every surgeon has the ability to do what I do,” Mitchell said. “The question is whether they are passionate in order to do it or comfortable to do so. What I specialize in are the larger cases.”

He cites research showing that plastic surgery can help a patient maintain weight loss. A study in the October 2013 journal Plastic and Reconstructive Surgery found those who underwent body contouring regained an average of 11 pounds, compared with 50 pounds for those who did not undergo surgery.

The plastic surgery may be “the final hurdle to get somebody to the place they’ve always wanted to be,” Mitchel said. “To me, that’s the rewarding part – to be able to be involved in someone’s life and to be able to make that final difference.”

Belly button makeovers: Doctors help shape the ‘perfect’ navel

By Joan Raymond-TODAY contributor


Considering that the human belly button is really nothing more than a scar from a cut umbilical cord, it seems a little strange to waste time gazing at your navel. That’s easy to say if you like the looks of that little “innie,” which is hopefully centered between your hips.

But for many people, a misshapen, misaligned, protruding or even missing belly button is a source of embarrassment. Fortunately, there’s a fix, and a new study published in ASJ, the journal of the American Society for Aesthetic Plastic Surgery, is providing doctors a road map to create what may be the “perfect” belly button.

Before and after belly button surgery

American Society for Aesthetic P
Before and after umbilicoplasty, or belly button surgery.

Using a computerized tool called the “Aesthetic Analyzer,” surgeons from Singapore tried to determine the optimal position of the belly button both vertically and horizontally, as well as its length and its shape. Pictures of Playboy playmates (37 to be exact) served as the source of “beauty.”

What they found was the beautiful belly button has a vertical ratio of 46:54, a midline horizontal position, a length that is 5 percent of the length from the xiphoid process (the lower part of the breastbone) to the lower limit of the vulvar cleft, and an oval shape with no hooding (29.8 percent) or superior hooding (21.6 percent).

In English, that means essentially the beautiful belly button is small, vertically oriented, and has a tiny flap or “hood,” explains Miami plastic surgeon Dr. Adam Rubinstein. “Using Playboy playmates is kind of an arbitrary sample. Just because these women are considered beautiful doesn’t mean they have beautiful belly buttons,” he says.

What people really want is to be in the “range of normal,” says Rubinstein. That means that most people want an “innie” even though an “outie” isn’t abnormal, and they want it proportional to their overall abdominal region. And there are some people who simply want a belly button.

“Adults can lose their belly buttons after a tummy tuck, for example, if the surgeon doesn’t create one, and sometimes they lose it just through another type of stomach surgery,” Rubinstein says. “Sometimes the belly buttons that are created are just really bad looking.” Weight gain, pregnancy and umbilical hernias can also make the belly button less than appealing. The procedure used to create a belly button is called an umbilicoplasty and it only takes about 30 minutes to about an hour to perform.

CoolSculpting Seminar – October 1st – Cosmedica 514-695-7450

English Cool_seminar

Séminaire CoolSculpting- le 1er Octobre – Cosmedica 514-695-7450


Research underway to develop artificial tissues for transplant

by:Lindsay Kalter

The concept of constructing organs out of nonhuman material may sound like science fiction, but according to bioengineer Ali Khademhosseinir, these technologies are well on their way to being deployed.

“We can take cells from a person and combine them with other things to create tissue outside of the body, then transplant it back into the person,” said Khademhosseinir, of Brigham and Women’s Hospital.

Tissue engineering research uses a combination of living cells and degradable foams. The cells are initially placed on these degradable materials. As the cells start to populate the area — putting down “pillows” to cushion the area for the creation of new tissues — the foam begins to degrade.

Over time as the foam fully degrades, the cells reorganize themselves to form tissue-like structures.

“Cells are pretty smart. They have evolved to be able to make new tissues,” he said.

The technologies have been used to make simpler tissues like skin and cartilage in patients, but more complex tissues, like those in organs, have yet to be achieved.

Khademhosseinir’s team has, however, been able to create artificial heart tissue that closely resembles natural tissue — and which can actually beat.

Researchers at BWH also recently began researching the use of 3-D printing to create blood vessel-like structures, which are then covered with cells to create new tissues.

“The idea is to be able to one day take an image of a tissue that you want to make, put it in a computer, and the computer would literally print the cells and materials in the structure of the cells you want,” Khademhosseinir said. “Then we’d hopefully use them to make things like a piece of heart or liver or bone.”

Grant money from the National Institutes of Health was used for this research, and tissue engineering funding at BWH also comes from the Department of Defense. Philanthropic funding is growing as well, Khademhosseinir said.

Five things plastic surgeons should avoid – American Society of Plastic Surgeons

1) Avoid performing routine mammograms before breast surgery.

Mammograms should be ordered based on existing clinical practice guideline recommendations, for patients undergoing breast surgery, including non-complicated breast augmentation, mastopexy, and breast reduction. Existing clinical practice guidelines recommend annual screening mammograms for patients of specific age groups. There are no recommendations for patients undergoing elective breast surgery to undergo additional screening unless there are concerning aspects of the patient’s history or findings during a physical exam which would suggest the need for further investigation.

Avoid using drains in breast reduction mammaplasty.

Although wound drains can minimize the amount of fluid at the surgical site, there is no evidence to support the use of drains. Evidence also indicates that the use of drains neither increases nor decreases postoperative complications, causes greater patient discomfort and possibly increases the length of the hospital stay. In patients that have liposuction as an adjunctive technique to the breast reduction, the decision to use drains is left to the surgeon’s discretion.

Avoid performing routine and follow-up mammograms of reconstructed breasts after mastectomies.

Evidence indicates that clinical examination is sufficient to det ect local cancer recurrence in patients undergoing breast recon struction after complete mastectomy. Current clinical practice guidelines recommend regular clinical exams for detection of breast cancer and imaging studies are not recommended as a part of routine surveillance . However, diagnostic imaging is indicated if there are clinical findings and/or clinical concern for recurrence. In cases of breast reconstruction after partial mastectomy or lumpectomy, mammography is still recommended. It is also important to continue mammography of the opposite breast i n women who had a unilateral mastectomy.

Avoid performing plain X-rays in instances of facial trauma.

Evidence currently indicates that maxillofacial computed tomogr aphy (CT) is available in most trauma centers and is the most s ensitive method for detecting fractures, in instances of facial trauma. Evidenc e also indicates that the use of plain X-rays does not improve quality of care, causes unnecessary radiation exposure and leads to substantial increase in costs.

Use of plain X-rays for diagnosis and treatment is helpful in instances of de ntal and/or isolated mandibular injury or trauma.

Avoid continuing prophylactic antibiotics for greater than 24 hours after a surgical procedure.

Current evidence suggests that discontinuing antibiotic prophyl axis within 24 hours or less after surgery is sufficient in preventing surgical site infection compared to continuing antibiotic prophylaxis beyond 24 hours after surgery. Prolonged use of antibiotics may increase the occurrence of antibiotic resistant bacteria and increase the risk of other infections. This recommendation is also supported by the Surgical Care Improvement Project, which is a national quality partnership of organizatio ns interested in improving surgical care by significantly improv ing surgical complications. In cases where a surgical drain is placed next to a prosthetic device (breast implant or tissue expander), there is not enough evidence to recommend discontinuing antibiotics and therefore t he decision is left to the surgeon ’s discretion.

Surgeon saves severed thumb of machete victim

The Bradford shopkeeper who had his whole thumb sliced off by a machete has had it successfully re-attached by a top consultant plastic surgeon.

Tasawar Iqbal suffered the appalling injury as he defended himself against five raiders at his Wibsey convenience store last Wednesday night.

He raised his right hand to shield himself from a machete – which cut straight through the v-shaped gap between his thumb and forefinger and down through his wrist bones, totally removing the whole digit.

He was rushed to Bradford Royal Infirmary where consultant plastic surgeon Ajay Mahajan went straight from a seven hour emergency operation on a child and started work on Mr Iqbal at 4am on Thursday.

“The machete blow had severed his entire thumb having entered what we call the first web space between the thumb and first finger,” Mr Mahajan said.

“He had caught the full force of the blade which then went down to the wrist, inside the heel and taking the thumb completely.

“Re-attaching a thumb is more complex than putting a finger back on as it does so much more than the other digits. It does much more flexing and rotation and uses bigger muscles to do so,” said Mr Mahajan, who heads the hospital’s famous Plastic Surgery and Burns Research Unit.

“The first thing was to put the bones back together to create a structure to build on,” he said.

“Then I joined up the arteries, veins, tendons, nerves, ligaments and muscles.”

Mr Mahajan said the sharpness of the machete’s blade had actually made it an easier task than if the thumb had been ripped off in an accident. It was easier because the tissue and everything had been neatly cut. But the main thing was that the thumb had been properly preserved.

Amazingly, by Friday Mr Iqbal had already regained some movement.

North Jersey docs offer tips on avoiding the plastic surgery nightmares of some celebs


March 24, 2014 Last updated: Monday, March 24, 2014, 1:21 AM

kimnovakThe signs of aging have been creeping up for years — marionette lines around the mouth, under-eye pouches, the dreaded neck wattle just like the one your mom had. But then, one day, you look in the mirror and think, who the heck is tha


t person looking back at me? And that’s the day when you may resolve to look into what cosmetic facial procedures are out there.
But then you tune in to one of TV’s many star-studded awards shows and see something scarier than “The Following,” “Hannibal” or


“Bates Motel” — once beautiful and familiar faces that are now lumpy, puffy, frozen, barely even recognizable.

Take, for example, the recent Academy Awards, when the appearance of 81-year-old Kim Novak, 68-year-old Goldie Hawn and 60-year-old John Travolta generated lots of tweets and morning-after buzz. They join a long list of celebrities — including Mickey Rourke, Joan Rivers, Bruce Jenner, Kenny Rogers and Priscilla Presley — whose apparently bad facial work has inspired online ridicule and troubling questions. One of them: If Hollywood’s rich and famous could end up looking so bad, what chance have I of looking good?

“The nagging problem in our industry is that our good results — Mother Nature gets the credit. And our bad results are there for everyone to see,” says Dr. Richard D’Amico of Englewood, the 2008 president of The American Society of Plastic Surgeons, who saw enough of the latter to have been cringing as he watched this year’s Oscars. “If it looks like plastic surgery, then it’s bad plastic surgery. Good plastic surgery is something you’d never think of. You look at the person and say, ‘She looks good and she looks natural.’ That’s the good plastic surgery, and we get no credit for it.”

D’Amico and other North Jersey board-certified plastic surgeons say that patients often mention famous people that they do — or do not — want to wind up looking like. “Earlier today, I had a woman who came in for facial rejuvenation, and she said, ‘I just don’t want to look like the people I saw on TV the other day,’ and she was referring to the Oscars,” says Dr. Luis Zapiach, who has offices in Paramus and Franklin Lakes. “I told her, ‘I’m a very conservative plastic surgeon. I will make you refreshed and that’s it. … And she was very happy with what we had done, just with fillers. She was very concerned about not having her cheeks too full. Some of the things that we see sometimes on TV is their cheeks are too full.”

Dr. Valerie Ablaza, who does 80 to 85 percent cosmetic work (much of it facial rejuvenation) in her Montclair private practice, often has to reassure patients who bring up celebrity mishaps.

“Everyone says the same thing, ‘How did someone do that?’ ” says Ablaza, last year’s president of the New Jersey Society of Plastic Surgeons. “I don’t know why those people and their handlers don’t see that just like the common people see what happened to that person. But I know that no one that walks out of my office looks like Kim Novak or Goldie Hawn.

“Even Priscilla Presley and Mary Tyler Moore and Carol Burnett — they all just look a little bit freaky and you say, ‘Really, who’s giving you advice?’ Why did Priscilla Presley have silicone injections in her face when it’s not even approved by the FDA in this country? … You’d think that they have all the money in the world and all the exposure, they must be going to the best. But they aren’t. They’re just in their own little bubble of thinking.”

Ablaza believes that some celebrities “get carried away … and keep making changes, little by little, and they get so far off the mark,” they may even lose sight of their “starting point.” (She speculates that this may be the case with Joan Rivers.)

D’Amico has also had patients say, ” ‘I don’t want to look like blank.’ Fill in any number of those blanks,” he says. “People come in and they say, ‘Don’t change me.’ And what I explain to them about facial rejuvenation surgery is that time and the environment and stress has changed you. So, it’s restoration, never alteration. What you saw in Kim Novak and Goldie Hawn is alteration, and that’s always a mistake.”

Dr. David Abramson, chief of the department of plastic surgery at Englewood Hospital and Medical Center, says, “I think, unfortunately, a lot of these people do too much, whether it’s surgery or fillers. If you overdo something, you wind up with abnormal facial expressions. They always talked about that ‘Joker’ look from having too many face-lifts, but I think when people have too much non-operative stuff they can look just as bad because they can look puffy, swollen.”

To be sure, many older actors and actresses look great, including 64-year-old Meryl Streep and 56-year-old Ellen DeGeneres, the Oscars host, who quipped that night that “the most important thing in the world is youth.”

“The ones that looked good, but didn’t look like they had something done, you bet your boots they had something done,” says D’Amico, an assistant clinical professor of plastic surgery at New York’s Mount Sinai School of Medicine.

Although women in general account for the vast majority of all cosmetic procedures — 91 percent in 2012, the most recent year the American Society of Plastic Surgeons released data — the gender breakdown is surely less lopsided in Hollywood, where looking good is in everyone’s job description. Travolta, after all, was among the Oscar-night stars who raised eyebrows (and not just for mangling Idina Menzel’s name).

While a character actress like 84-year-old June Squibb may feel no need to hide her gray hair and wrinkles, aging can be especially tough for those once known for their looks, as Cameron Diaz told Oprah Winfrey on the March 16 episode of “Oprah Prime,” which also featured Sharon Stone. “It’s almost as if we have failed if we don’t remain 25 for the rest of our lives,” Diaz said.

While most of us don’t have millions of strangers watching as we age, the process is the same for celebrities as for everyone.

“When we’re young, the skin has a lot of elasticity, so all the rubber bands are nice and tight and the dermis is very thick with collagen and plump, and tight skin and plump skin is young skin, and that looks very good,” says Dr. Barry DiBernardo, a Montclair plastic surgeon and past president of the New Jersey Society of Plastic Surgeons. “Somewhere around 35 years old — it’s different in all of us, it depends on your genetics, your sun damage, your smoking — those cells will slow down the production of collagen and elastin, and that’s when you’ll start to see the lines come in. The skin thins. Things start to fall.”

The good news, the doctors say, is that there are now many non-invasive and minimally invasive options for rejuvenating faces, including toxin injections (such as Botox, for forehead wrinkles) as well as fillers like Radiesse or Voluma (for, say, cheeks); Juvéderm (for nasolabial folds); a newer, lighter filler called Belotero (good for lower eyelid hollows); and fractional lasers to resurface and tighten the skin.

“We now have more tools in our toolbox than ever,” D’Amico says. “It used to be, you held out and you went right into the operating room at some point. Nowadays, we have all different levels of intervention.”

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