Tanushree’s cosmetic wonder

NOTHING SEEMS to be going right for former Miss India turned actress Tanushree Dutta after the entire Nana Patekar fiasco! Bad luck seems to be following her everywhere.

More recently the director of her forthcoming film Saas Bahu Aur Sensex has allegedly called Tanushree "difficult, arrogant and moody."

A source close to Shona Urvashi reveals, "Tanushree was difficult to handle and would continuously throw tantrums and misbehave with the other cast and crew. In fact, at times Shona Urvashi would get so fed up with her because she would take more than 20 retakes for a scene whereas the other actress Masumeh Makhija, Shona's sister, would do it in just one shot."

Buzz is that Tanushree completely disassociated herself after shooting for the film concluded and kept cancelling her dubbing dates for the film.

Reportedly, Shona Urvashi has got Tanushree's voice in the film dubbed and Tanushree is now worried if her director has chopped some of her scenes as well! A source close to Tanushree reveals, "Tanushree is the only popularly known face in Saas Bahu Aur Sensex. The film also has Shona's younger sister Masumeh and so naturally Shona Urvashi doesn't want Tanushree's performance to overshadow her sisters!"

When we got in touch with Tanushree the actress was extremely vocal in expressing her displeasure with Shona Urvashi. She said, "Working with her Shona was a nightmare, and I don't even want to recall that experience. I know that she has been gossiping about me and calling me names but I don't care. This is her second film and she needs a lot of publicity but this isn't the way to go about it."

Recalling her terrible experience while shooting for this film Tanushree reveals, "She would harass me without a reason. She's accusing me of giving too many takes but the truth is she'd make me repeat the same lines over and over again for hours. She wouldn't even allow me to retreat to my van in between shots. I shot continuously for 15-hours and when I'd reach my vanity van the lights and air conditioning in it would be switched off!" But Tanushree stresses, "The film has a fantastic script so I continued taking the harassment. But it was the worst experience of my career!"

However, director Shona Urvashi refuses to comment on the issue and nor does her sister Masumeh.

Controversies seem to be following Tanushree everywhere. Recently the actress appeared looking different at a promotional event for her film sparking off rumours that she had undergone some form of cosmetic surgery. An extremely well placed source in the industry reveals, "Tanushree has definitely undergone cosmetic surgery and this piece of advice was given to her by Koena! Koena is Tanushree's advisor in Bollywood, both of them are the thickest of friends and Koena has been advising Tanushree on everything from what films to sign to what outfit to wear!"

Koena admitted to having done jobs on her face and spoke of the bad job that was done on her nose. In fact people said that she looked more attractive before she had all this done. Koena even admitted she had to go into hiding just after the nose job because it looked so obvious. One can only wait and see if Tanushree's altered look can help her career or will it also go down the drain like good friend Koena's? Maybe she should work on making friends in the industry and stop upsetting filmmakers.

Said an inside source, "Tanushree is a very fine person. She just does not have tact and has many preconceived notions about certain things. So basically she is very misunderstood."

Nurses can give Botox injections

Botox is booming, here and abroad.

And thanks to a ruling by the Ohio Board of Nursing, the wrinkle-smoothing toxin is likely to help some Ohio medical practices improve their own lines -- their bottom lines.

Last week, Allergan Inc., the pharmaceutical company that makes Botox, said its second-quarter profit rose 6.9 percent, well above analysts' estimates, largely because of robust sales of the facial treatment overseas. Overall, Botox sales jumped 13 percent, to $315.5 million.

A survey by the American Society for Dermatologic Surgery suggests that the use of Botox and dermal fillers is up in the United States, too, in spite of -- or perhaps because of -- the sagging economy and rising unemployment. In a news release detailing the findings, the organization speculated that "baby boomers may be looking to put their best face forward on the interview circuit."

In Ohio, Botox sales could get an additional boost from the recent determination that nurses can give Botox injections, provided that they first undergo special training.

The financial advantage is obvious: By assigning the duty to nurses, medical practices that offer Botox can treat -- and bill -- more patients. And because health-insurance plans typically don't cover elective cosmetic procedures, practices can deal directly with patients and charge, for the most part, whatever the market will bear.

In 2006, the most recent year for which data are available, physicians across the country charged an average of $492 for a Botox injection, according to the American Society of Plastic Surgeons.

Because Botox is a poison, some states explicitly forbid anyone other than a licensed physician to administer the drug.

Before the nursing board ruled on the matter last month, however, Ohio's nurses were operating in uncharted territory. Some were giving Botox shots -- and even determining doses. Others thought the procedure was beyond the scope of practice for nurses and therefore could be performed only by a physician.

"There was no specific prohibition," said Lisa Emrich, manager of the board's nursing practice, education and administrative unit. "It was becoming evident that physicians wanted nurses to do this, and there were no specific guidelines."

The board's decision came in response to a request by Dr. Fernando Colon, a board-certified plastic surgeon and associate medical director of the Skin Center Medical Spa in Gahanna.

Colon argued that allowing nurses to do the procedure would enable him and his colleagues to serve patients more effectively and efficiently.

"A well-trained nurse can continue to repeat this treatment, while I'm at the office doing other things," he said. "In a well-supervised environment, I think it is safe for a nurse to administer these Botox injections."

Colon's request, submitted last year, sparked months of discussion, much of it focusing on potential complications.

"What happens in a bad outcome?" board member Eric Yoon, a nurse practitioner from Springboro, asked at one hearing. "Just call 911?"

Ultimately, the board agreed with Colon but said nurses first must complete a "preceptorship," a period of practical experience and training supervised by a physician, Emrich said.

The board also determined that Botox can't be administered in homes, beauty salons or shopping malls, she said.

Still, some Ohio physicians aren't happy with the decision.

Dr. Michael Sullivan, a board-certified plastic surgeon in Columbus and former director of facial, plastic and reconstructive surgery at the Ohio State University Medical Center, had testified that Botox injections should be left to experienced plastic surgeons or dermatologists.

In unqualified hands, Sullivan said, the drug can cause a number of problems, including muscle weakness, drooping and bruising.

"We're going to hear of more and more complications and potentially deaths, because more and more physicians want to get out of insurance medicine and look at Botox and fillers and some of these quick procedures as a way to create a lucrative practice," he said.

In February, the U.S. Food and Drug Administration reported that Botox had been linked "to adverse reactions, including respiratory failure and death, following treatment of a variety of conditions using a wide range of doses." The most serious side effects stemmed from the "off-label" use of Botox to treat limb spasms in children with cerebral palsy, the agency said.

Last month, more than a dozen people filed a lawsuit against Allergan in California, where the company is headquartered. The plaintiffs contend that Botox injured them or killed their relatives and that Allergan failed to warn them of potential dangers.

Allergan said Botox has been used safely by millions of people.

Weight loss surgery escalates in WA

A new study has revealed an explosion in weight loss surgery procedures in Western Australia over the past two decades.

The study by the University of Western Australia's School of Population Health is published in the latest edition of the Medical Journal of Australia.

It found there were 20 times more bariatric procedures, such as gastric banding, performed in 2004 than in 1988.

Sixty-four-year-old Pamela Vigers was an acute diabetic who weighed 116 kilograms. She lost 40kg after surgery and says it has changed her life.

"I don't take insulin or any type of diabetic medication, the diabetes is totally under control because I can exercise now," she said.

Researchers say while the study focussed on WA, the increase is indicative of a national trend.

The study's co-author Fiona Smith says much of the rise can be attributed to the worsening obesity problem.

"Certainly we found that some of the rise in the surgery can be attributed to the increasing population prevalence of obesity," she said.

"There are other likely factors though - things like increasing publicity and awareness of the surgery."

Ms Smith says the research also found the surgery is safe.

"There was relatively few complications recorded and very little difference in survival outcomes between the bariatric surgery patients and the general population," she said.

Australian Medical Association national president Rosanna Capolingua says the surgery has improved over the past two decades.

"Certainly there have been improvements in this sort of surgery over that period of time," she said.

"Laparoscopic surgery is now available. It is safer, it is a more realistic option."

But Ms Capolingua says surgery should only be used as a last resort.

"It is an appropriate treatment after other methods of weight loss have failed and in certain groups, [for example] patients with a BMI over 35."

THE FIVE-MINUTE MAKE-UP CHALLENGE

Make-up guru Barbara Daly, creator of Make-up by Barbara Daly, available at Tesco:

If you are short on time, but need to freshen up your make-up before going out, cleanse your face and touch up with concealer. Blend a creamy mousse blusher over the apples of your cheeks and a little into the sockets of your eyes as well as on to your temples for an instant glow. You can smooth a little blusher over your lips too and top with gloss for a pretty, co-ordinated look. Finish off with a light dusting of face powder to set the look.

Make your eyes look more wide-awake by using lash-curlers and by painting a tiny triangle of highlighter onto the inner corners of your eyes. Try Make-up by Barbara Daly Glow-Up (£6, Tesco), a luminous, multi-reflective highlighter.

A good foundation like MAC's Studio FIx provides an ideal base from which to create a fast, flawless look

Celebrity make-up artist Cassie Lomas:

Start with a flawless base -  MAC's Studio Fix (£19, www.maccosmetics.com) is an all-in-one foundation and powder base which provides good coverage and is really quick to apply, with a brush, sponge or powder puff. It creates a matte, velvety finish.

To achieve instant glamour for eyes, use a cream shadow, such as RMK'S cream shadow, and apply with the wand across the eyelids. Then apply one coat of Bourjois' Volume Clubbing mascara (£7.95), which has a double-sided brush, just one sweep of the wand gives lashes instant fullness and volume.

And for lips, try Bourjois' new Rouge Hi Tech liquid lip tints (£7.25), they are easy to apply for instant colour and I also use them as a blusher, by dabbing a little into the apples of the cheeks for a fresh look.

Use a natural colour eye shadow for th base and apply a soft brown shadow on the upper lid

Celebrated Italian make-up artist Mario de Luigi, who has his own range of products, available exclusively on QVC:

Use a natural colour eye shadow (beige or cream) for the base - apply to the whole lid. Then with a soft brown shadow, line the contour of the upper eyelid, very close to the lashes and blend into the corner, use a sponge applicator or your fingertips.

The best way to apply mascara is by putting a mirror flat on the table and look downwards. Pull your eyelid up from the centre and when your eyelashes look like a flat fan, you can get right to the roots with your mascara wand and make them stronger and fuller.

Define eyebrows using a very pointed, neutral colour pencil. You can fill in where they are sparse. Eyebrows are very important as they give your eyes a frame. This will make your eyes look more intense. It's simple, but easy and effective.

Make-up Artist Anna Thompson:

Use your lipstick as a blusher. With so many lovely pink and coral shades around at the moment, it gives a lovely, fresh, summery look. If you're in a rush, try using a primer, such as Estee Lauder's Idealist Pore Minimizing Skin Refinisher (£34, www.esteelauder.co.uk) when doing your make up for a night out. It makes the skin feel perfectly smooth and makes applying foundation much quicker.

Cheap tricks: Vaseline gives a glowing shimmer to lips and cheekbones

Top hair and make-up expert Cinta Martello:

My favourite product is Vaseline (99p, Boots). It moisturises lips and enhances cheekbones - simply blend it into a peachy powder and apply to cheekbones for a fresh, glowing shimmer.

Dior AIRFLASH spray foundation (£29.50, 0207 216 0216) gives you a photographically flawless finish in under five seconds. Simply hold 10 inches away from your face and spray in a zigzag motion.

It provides full coverage that feels weightless on the skin. There is no need for blending, simply sweep over cheeks with a golden bronzer and you have the perfect base in under a minute. Invest in a multi-tasking product. Multiples, made legendary by Nars, are available from all good make-up brands. These double-up as lipstick, brow highlighter, eye gloss and cheek shimmer, so will also save space in your make-up bag. Try Nars Copacabana (£27, www.narscosmetics.co.uk).

Alan Pan, celebrity make-up artist:

Save the time and hassle by refreshing your foundation using Estee Lauder Spotlight Skin Tone Perfector (£23, www.esteelauder.co.uk).

It's a sheer highlighting lotion that puts the freshness back into your skin that a hard day's work takes away. Using a foundation brush, dab Spotlight on to cheekbones, the forehead and down the centre of the nose.

It can also be applied to your décolletage for a sexy evening look. The best way to make your lipstick last the day is to do it the old- fashioned way. Apply lip liner over the entire lip and then apply lipstick.

Blot gently with tissue, then apply a little bit of loose powder on top. Always carry a few essentials in your bag for quick top-ups throughout the evening - blotting sheets, a great concealer and your favourite lipstick will see you through the night.

Don't brood over your fat belly!

Troubled with the fat accumulating in your lower belly and thighs? Well, then here's a reason to rejoice a little— the fat in these areas of your body is rich in stem cells, which hold great scientific potential.

This first of its kind study sought to examine whether fat tissues from different areas of the body vary in stem cell concentration.

The researchers found that fat removed from the lower abdomen and inner thigh through liposuction was found to be an excellent source of stem cells, with higher stem cell concentrations than other areas of the body.

"Adult stem cells, derived from our own tissues, hold strong promise for improved clinical therapies," said J. Peter Rubin, MD, a member of the ASPS Fat Grafting Task Force who is involved in pre-clinical trial work on stem cells taken from fat.

He added: "The potential for healing and repairing injury or disease through stem cells, including conditions like breast cancer and reconstruction, heart failure, spinal injuries, diabetes and Parkinson's disease are incredible. We may be able to more permanently and naturally get rid of pesky wrinkles or augment breasts with stem cell enriched fat in the future as well. Knowing more about the biology of stem cells will be of great value when we are ready for clinical trials in this country."

The study was conducted on 23 female patients having liposuction in at least four different body areas, who agreed to have their fat isolated for adult stem cells and analyzed to determine stem cell concentrations. The body areas that were liposuctioned were: lower abdomen, upper abdomen, inner knee, inner thigh, flank and hips.

The results indicated a significant difference in stem cell concentrations in different areas of the body. A major finding was that the concentration of stem cells was greatest in the lower abdomen and inner thighs. In fact, stem cell concentration in the lower abdomen was five times greater than in the upper abdomen.

"The value of stem cells harvested through fat is the ready and ample supply available. Using stem cells will some day have very practical applications to the specialty of plastic surgery. That we may be able to generate new tissue or bone that can be used in many of the reconstructive and cosmetic procedures we do every day is a tremendous," said ASPS President Richard D'Amico, MD.

Stem cells are unspecialized cells that have not yet developed a specific function. Not only are they capable of self renewal, stem cells can divide and produce others that become specialized cells. Scientists and doctors theorize that stem cells will be able to repair or replace damaged or diseased cells.

Liposuction Expert On What’s New, What’s Old & What Works

As a physician and surgeon, one of my main responsibilities is to honestly guide, educate, advise and protect my patients. As liposuction surgery is the only major cosmetic surgery I perform and I have done this procedure for 14 years for thousands of patients, I have a lot of opinions and insight into the nuances of consistently achieving a great result and making my patient happy. I have spent years fine tuning my approach and have a particular philosophy on what constitutes a good candidate for liposuction. It is so much more than sucking out or melting as much fat as possible. Despite what a patient may want or the mistaken goal of a surgeon, this approach will commonly lead to a poor result.

One of the most important points I want to emphasize is the importance of choosing the honesty, integrity, artistry, eyes, hands, skills and good judgment of the surgeon over the machine. The machine is only a paint brush in the artist's hands. Despite interesting technology and aggressive marketing hype, it will not guarantee a great result in a trusting patient. A concerning trend I have seen in the last few years with the introduction of some of this interesting technology is the mistaken tendency of the patient to choose or ask for the machine instead of spending time to find the right surgeon. Unfortunately, companies, the media and sometimes even doctors themselves contribute to this when there is competition for dollars. Like I say on my radio show (and you are doing so by reading this article), please do your homework and spend time educating yourself. Do not be impulsive, continue to learn and hopefully the truth will come to guide you to a great result.

Presently in the United States, liposuction is still the most common cosmetic surgery. It also has one of the highest revision rates approaching 25% in some studies. It is much more difficult than most patients and even many naïve surgeons realize to consistently get a beautiful result. There are many reasons for this as we will start to see. I feel it is extremely important to "get it right" the first time. Every aspect of this procedure from clear honest communication with the patient, to complete evaluation, to meticulous technique should be directed toward this end. If a patient is not a candidate, e.g. they are simply overweight, maybe out of shape but not disproportionate, then I may have no role in their improvement and honestly tell them they are not a candidate for liposuction.

Unfortunately, approximately 30% of my surgeries are revision liposuction where I am using techniques to improve a bad or less than optimum result by another physician or possibly non-physician. In my evaluation of this patient, I can always tell why a bad result has occurred. A bad result occurs for two reasons: either poor evaluation (including poor communication) or poor technique. The surgeon may have been too conservative, been too aggressive (too common), been uneven in his contouring, poorly blended areas, placed his incision points in strategically poor locations or thrown a patient out of balance and proper proportion. And once again, unfortunately no new technologically advanced machine can or ever will prevent any of these problems. Like a perfect haircut or a beautiful sculpture, it goes back to the skills and artistry of the person doing it.

With liposculpture surgery, as with any procedure, a great result begins with a complete honest evaluation as to who is a good candidate. Simply stated, liposuction is all about targeting areas of genetic disproportion and balancing a body. It has virtually nothing to do with being overweight, underweight or normal weight. It is about focusing on stubborn areas that can't be taken care of with diet or exercise. This is one reason why it is so important to be fully evaluated from your neck to your ankles by someone with a good eye and ability to determine where you are out of balance if at all. It is a mistake to perform liposuction on someone who is simply overweight or out of shape but not disproportionate. Once again, unfortunately this does not uncommonly occur and the result will be a person thrown out of proportion. This is why we hear of cases of people who had lipo and the fat "went" to other area. The surgeon created disproportion. In addition, make sure that the person who is evaluating you for surgery is actually the surgeon and not somebody else. I have heard of patients who met their surgeon for liposuction in the operating room for the first time. Be wary of places that seem like factories and do not truly care about comprehensive individualized care.

With regard to my own approach to liposculpture, I strongly feel that local anesthesia is the gold standard and offers many advantages over general anesthesia for liposuction specifically. This is called "tumescent" liposuction which was developed by a dermatologic surgeon. I like to call this pure tumescent liposuction to differentiate it from other types where they maybe combining it with general anesthesia. Tumescent liposuction has essentially three major benefits. To begin with, studies show it is far safer, especially if compared to liposuction done with other procedures under general anesthesia. The second benefit is easier recovery. The tumescent fluid which is infiltrated into the fat helps hydrodissect (separate with water) and allows much more pure fat removal with decreased bleeding. This results in far less bruising and generally much faster recovery with less post operative discomfort. I only trust myself to do all the local anesthesia as there certainly is an art to infiltration so that the patient feels as little as possible. However, the greatest advantage of local anesthesia is that I have a patient that can always be positioned optimally, so that I can meticulously sculpt without ever jabbing the muscle or poking the skin. This allows me to stay only in the fat layer where I only belong. Jabbing the muscle (which could never be tolerated with a conscious patient) significantly increases bleeding, bruising and postoperative pain. On the other hand, jabbing, poking or tenting the skin with the cannula at the wrong angle is one of the main causes of indentations and irregularities (as we will soon discuss).

With regard to my technique of sculpting, it begins with a good eye for the contour, balance and proper proportions for the male and especially the female body. Each body has its own differences, nuances and limitations. Good surgical technique also encompasses excellent judgment for not only where to target but also how aggressive to be. There must always be respect for skin tone as well as knowing how to deal with looser flabby tissue (flab is the term I use which is loose skin and muscle. Many people confuse flab with fat.)

Where I have learned to place my incisions in each part of the body I approach is extremely important. The goal is not only to place few incisions in places that hide well, but to strategically place them to be able to completely and evenly approach each area without jabbing the muscle or skin. My incisions are small nicks in the skin between two-three millimeters in length. I feel that not suturing the sites allows faster recovery by drainage of fluid postoperatively.

With regard to how I sculpt, this is a little more difficult to convey in words. The fat is embedded in a fairly dense connective tissue framework so it certainly is not just sucking fat out. One must tunnel very precisely in the fat and this is why liposculpture is truly a more accurate name then liposuction. I always start deep in the fat with small round cannulas to debulk the deeper layers of fat. I almost always approach an area from two or more directions and crisscross my tunnels. As I move up in the fat layer, I progressively go to even smaller cannulas and finish in the superficial fat layer with a flat tipped small cannula I had designed for myself many years ago to make sure my surface is smooth. It is how I approach this superficial fat and how aggressive I choose to be with regard to rasping the dermis from underneath that controls how much skin tightening I choose to achieve. Liposculpting is a very tactile procedure and this is one of the main reasons why I do not prefer laser assisted liposuction or ultrasonic liposuction as I lose the "feelings" or vibrations which convey to me exactly where I am and how much I am bringing an area down. Remember, the goal is not to always be aggressive and just suck all the fat out. This is a very amateur approach and bad results will commonly occur. For a more detailed description of how I approach each particular area of the body, please consult my website www.expertliposuction.com in the section entitled "area by area."

Now, with regard to alternative liposuction procedures, I will group them into internal and external modalities. With regard to the internal modalities, I will begin with mesotherapy (also known as lipozap or lipodissolve) as it will be the quickest to dismiss. One of the deceitful marketing tools is that mesotherapy many times is advertised as being better than liposuction. I find this not only inaccurate but insulting. Mesotherapy is the multiple injections of a nonstandardized solution of phosphatidylcholine into the fat. Now, I am not saying that it won't ever dissolve fat because it might. But remember when I said that the fat is embedded in a dense connective tissue framework? Well, how do you control the dispersal of the fluid and trust you are going to dissolve everything evenly? Remember how particular I was in how I sculpted each area of the body? There is so much more involved to great liposculpting then just dissolving fat. And, not that this is the most important thing, but mesotherapy is not FDA approved, is not supported by any of the major cosmetic surgery societies and furthermore, no one that I know who specializes in body sculpting has chosen to incorporate it in their practice.

Laser assisted liposuction (eg. Smart lipo, cool lipo) and ultrasonic liposuction (eg. Vaser) are newer quite popular alternatives to more traditional forms of liposuction. The argument here goes that they melt fat and tighten skin, whereas traditional liposuction either does not tighten skin or makes your skin looser. Very alluring, but it's not that simple or truly accurate. I sometimes call this liposeduction vs. liposuction. There are many surgeons that have embraced these newer machines. Personally, I do not trust simply melting fat and feel I can get as much tightening as I choose by how I deal with the area just under the skin. I prefer this because it gives me more of a feel. With regard to the laser sealing blood vessels, remember that with properly done tumescent anesthesia one gets very little bleeding due to the hydrostatic pressure and epinephrine vasoconstruction. One well done study in a major peer reviewed journal (Plastic and Reconstructive Surgery Sept. 2006) failed to demonstrate any clinical advantages of laser assisted lipoplasty.

However, I feel the bigger danger with many of the newer aggressively marketed machines is that they encourage the potential patient to search for the machine and forget that what is more important is the mind, hands, heart and eyes of the man (or woman) behind it. Since I do a lot of revision work to improve poorly done liposuction, I would have to say that in the past two years I have seen some of the worst disasters result from both laser assisted and ultrasonic liposuction. Once again, I don't blame the machine but the judgment and skills of the person behind it. I am also aware that the media plays a large role in hyping up whatever is new.

Finally, with regard to many of the newer machines that are targeting either cellulite or tightening of the skin, I feel this is an interesting area as long as it is not too closely compared to well done liposculpture. There are some promising results with regard to this area. Velashape was the first FDA approved machine for cellulite and the temporary reduction of circumference (yes, temporary). There are other machines also used for cellulite. While this is a very intriguing area, I have not yet chosen to incorporate it in my practice as I am not yet sure it really works long term and is worth the cost of the procedures. There are also several skin tightening machines that are used on the body such as Titan, Thermage, which uses radiofrequency, and Affirm. Recently Thermage came out with a deep penetrating tip that penetrates over 4 mm and generates an inflammatory response in the superficial fat layer to generate tissue tightening and shrinkage. I am in the process of forming my opinion as I am starting to use this deep tissue tightening tip to further tighten skin on the body. But I have to admit that it is quite expensive and at least in my hands and eyes, the verdict is still out. But I will keep you posted.

In closing, I hope the insights and opinions I have shared help to guide you in the right direction.

Lying awake for liposuction

Those desiring to fine tune their bodies with liposuction but leery of being knocked out from general anesthesia have an ideal alternative - stay awake.

Claudia Estes of Jackson had no problem with the idea.

"I was more afraid of the general anesthesia," Estes said. "I've had liposuction two or three times over the last five years with no problems."

Estes decided to have the procedure to eliminate the infamous "muffin top" - the fold of fat around the mid-section that spills over the top of tight-fitting waistbands. "When the jeans became lower cut, I wanted to do something so I could keep up with the fashion trends," she said.

Very pleased with her results, Estes said, "This was pretty much instant gratification."

Traditionally, liposuction has been done with a patient asleep under general anesthesia. But now a patient can be fully awake with only a local anesthetic to numb the procedure area. Known as tumescent liposuction, this method involves injection of a large amount of saline solution, which contains additional anesthetic and epinephrine, directly into the areas where excessive fat deposits are to be removed.

"I perform liposuction from three to eight times every week," said Dr. Shelby Brantley, a plastic and reconstructive surgeon with The Plastic Surgical Center of Mississippi in Flowood.

Also known as lipoplasty, liposuction is the removal of excess fat deposits to improve the contours and proportions of the body. Thighs, hips, buttocks and abdomen are the most common areas for fat removal. Fat deposits also can be removed from the arms, back, chest, cheeks, chin or neck.

"We make a small incision in the skin and insert a small tube connected to a vacuum type machine to remove the fat deposits," Brantley said.

Staying awake can have major benefits. "When the patient is awake, he or she can move into different positions to help me see where exactly we need to remove fat deposits and achieve ideal results," Brantley said. "That way there is a better opportunity for symmetry."

Another benefit is cost savings. Without the use of general anesthesia, the cost of an anesthesiologist can be avoided along with the costs of post-surgical monitoring.

"Typically, the procedure will run from $1,000 to $5,000 depending on the number of body parts or areas being done," Brantley said.

Plastic surgery has lost much of the stigma once associated with the practice. Guilty pleasure television programs, like the cable series Nip/Tuck and Entertainment Tonight's latest report detailing which celebrities have had work done, have broadened public thinking about plastic surgery.

Women aren't the only ones having the procedure. Brantley said he's seeing a gradual increase of men having liposuction. "Men want to look as good as they can, too," he said.

The American Society of Plastic Surgeons reports liposuction is second only to breast augmentation in popularity among patients seeking plastic surgery. Roughly 300,000 Americans have liposuction each year.

Dorothy Baker of Indianola made a life-changing transformation last year. She lost more than 60 pounds and feels like a new woman. Diet and exercise had a lot to do with her makeover, but she also got a little extra help from her plastic surgeon.

"I'd already started to lose a lot of weight and I wanted everything to match," Baker said. In addition to a tummy tuck and breast reduction, Baker had liposuction to contour her waistline. "Within a month, I could see the transformation," she said.

Baker wasn't quite comfortable with the idea of being awake during her liposuction procedure so she went the traditional route of general anesthesia.

Baker and Estes noted similarly short recovery times with only mild discomfort and pain. "I had the procedure done on Friday and was back at work Monday morning," Baker said.

Estes drove herself home after her liposuction and was back to work the next day. She did, however, wear a compression garment for three weeks.

Dr. Stephen Davidson, a plastic and reconstructive surgeon also with The Plastic Surgical Center, noted that, while many people aren't aware liposuction can be done while awake, the technique has been around for more than a decade.

"We've been doing tumescent liposuction for years," Davidson said. "It's ideal for patients who only want one or two areas of the body done and who have smaller volumes of fat to be removed."

Davidson also noted liposuction is not a cure for obesity or the answer to major weight loss. "Liposuction takes areas that are out of proportion and puts them back in proportion with the rest of the body." Generally, patients should be within 25 to 30 pounds of their ideal weight.

There are risks whether you choose general or local anesthesia for the procedure. According to the American Society of Plastic Surgeons, uneven skin contours and rippling or loose skin may be evident after liposuction. And there is always a risk of fat or blood clots and infection with either method. Swelling and fluid retention are normal and usually subside within a few weeks.

Most importantly, Brantley and Davidson stressed the importance of seeking a board-certified plastic surgeon to perform liposuction.

"Interview the doctor. Find out how many times a week he does the procedure," Brantley said. "Ask to see before-and-after photos of his work."

Davidson said, "Talk to people who've had the procedure done. What were their results?"

Baker has referred a number of friends and colleagues for the procedure. "I'll tell anyone that if you can look this good and feel this good about yourself, go for it."

Latest Plastic Surgery Trend: Thin Shoulders Like Madonna & Keira Knightly

There is truly no body part today that is spared from plastic surgery and the shoulders are the latest area that some women may be looking to enhance.  Celebrities like Madonna and Keira Knightly have apparently set a new beauty standard for slender shoulders that some women are hoping to attain by going under the knife.

Some surgeons in New York are reporting a rise in women getting liposuction in their shoulders to vaccum out fat and achieve more defined shoulders.  The procedure seems to be a standard liposuction, where small incisions are placed in the natural creases and shadows of the shoulder area.  The surgeon then aspirates the fat out with a curved suction cannula (wand).  There are some surgeons who use laser-assisted liposuction like Smartlipo or Vaser to melt the fat and then suck it out.

"Many of my patients are now requesting shoulders like Madonna and Keira Knightley," said Dr. Douglas Steinbrech to the Daily Mail. The New York-based plastic surgeon said that the procedure costs between $4,000-$10,000, is relatively pain free and patients can return to work within a few days.

"I often perform the operation on a Thursday or Friday and they recover all weekend with anti-inflammatories and painkillers and go back to work on Monday," he said.

But not everyone believes that shoulder liposuction is going to be a growing trend or that it should be, as the shoulders are not typically an area that has accumulations of fat as other body areas.  If someone really has a lot of fat around the shoulders, they probably need to lose weight instead of thinking about liposuction in the area.

Beverly Hills, CA-based liposuction expert Dr. David Amron, who only performs liposuction at his practice, told Make Me Heal that he has never seen a candidate for shoulder liposuction in the thousands of evaluations.

"I do lipo on almost every area of the body and even many areas most people don't," said Dr. Amron.  "But the shoulders themselves are an area I have never seen that needs to be done".

"I strongly feel that if someone has fat shoulders then it typically is a musculoskeletal issue of larger muscles and bones and maybe that they need to lose weight.  Remember, lipo targets genetic disproportion of fat."

"I am not saying I wouldn't, but I have never seen a candidate for this area in thousands and thousands of evaluations."

"When I do lipo on the arms and upper back, which is quite common, the shoulders have a more defined look.  But I would not be marketing this as shoulder liposuction to have the look of an actress."

It appears that liposuction on the shoulders should really a last resort solution, as a patient is best advised to lose the weight first before considering a surgical option.  Moreover, if someone is going to get liposuction on the shoulders, one would think that they probably would need it in other areas as well to get a consistent toned look in the entire body.  But if you have the dough, and exercise and diet alone can't help you rid of that final pesky fat pocket on your shoulder, maybe shoulder liposuction may be right for you.

'I wanted to look good in my clothes'

Jamie Wishart, a 42-year-old property consultant from London, is one of a growing number of men in the UK choosing to have cosmetic surgery.

After a serious accident in his teens, Jamie's weight ballooned to over 18 stone (114kg) as he was dependent on steroids and unable to exercise.

After managing to reach 16 stone (102kg) through healthy diet and exercise, he was left with unsightly excess skin around his abdomen.

Jamie said: "I felt awful, in particular meeting clients.

"I always thought my suits didn't look right on me and it really affected my self-confidence.

"I have rolls of lose skin around my middle area and I decided to do something about it."

Research into options

Jamie carried out some research and decided that a tummy tuck (abdominoplasty) and liposuction would be one way to get rid of the excess skin on his stomach.

Dr Jag Chana, Consultant Plastic Surgeon on male tummy tucks

He chose Dr Jag Chana, a consultant plastic surgeon at Spire Bushey Hospital in Hertfordshire.

According to latest figures from the British Association of Aesthetic Plastic Surgeons. (BAAPS) more and more men are opting to have cosmetic surgery.

In 2007 the number of men choosing to have tummy tucks, a procedure most often associated with women, rose by 61% - although the total figure, of 90, is still relatively small.

Liposuction for men also increased by 18% to 582. It is now the second most popular form of cosmetic surgery for men, after rhinoplasty (nose jobs).

After a lengthy consultation, it was decided that - with a body mass index of 30 - it was safe for Jamie to undergo the five-hour combined procedure, costing £7,000.

Many not suitable

Dr Chana said many of the patients he sees in his clinic are actually not suitable to be operated on.

He stressed the decision to have liposuction or a tummy tuck was not a weight loss option.

Many people who approach him have a beer belly, which means they must first try to lose weight through diet and exercise, as the procedure is not designed to deal with a bloated physique.

I can't contemplate ever having my old body back Jamie Wishart

Instead, it is designed for those who have had some success reducing their weight, but as a consequence find themselves with folds of excess skin.

"This is not a lunchtime nip and tuck," said Dr Chana.

"Tummy tucks and liposuction are invasive procedures. Possible risks are scarring, loss of sensation and infection to the area, but these are rare.

"Patients can normally return to work after two weeks but exercise and lifting must be avoided for at least six weeks as an abdominal corset needs to be worn to support the area."

Experts advise finding a registered surgeon that has been recommended rather than finding consultants on the internet.

They predict that this area will continue to flourish in the coming years as more and more men begin to care about their appearance.

Dr Chana said there had been a 40% increase in the amount of men having operations at his practice last year - and with more and more enquiries and interest from men he is convinced this area will continue to boom.

Following his operation, Jamie said life at 14-and-a-half stone (92kg) is very different for him today.

"I can't contemplate ever having my old body back.

"Now I get out of bed and jump into a suit and that is important to me.

"I'm sure if most blokes were honest, we all want to look good and if you can afford to take advantage of things on the market such as cosmetic surgery, why not?

"The best thing for me - and people may laugh at this - is when I get up in the morning and do my belt up, my stomach no longer hangs over the edge. I think, 'Yes, I look good and this has all been worth it'."

More men going under the knife

To friends and colleagues, Frank Lococo's furrowed brow made him appear angry and confrontational. Not exactly personality traits you want as an advertising executive.

So the 37-year-old Milwaukee man opted for cosmetic surgery, joining the growing number of men willing to go under the knife — or for some, under the needle — in an effort to make themselves look younger and, hopefully, improve their careers.

"Being in advertising and marketing, there is a lot to how you look," said Lococo, of Milwaukee. "How you dress, what you drive, it all makes an impact on the overall presentation of you."

According to the American Society of Plastic Surgeons, in Arlington Heights, Ill., 1.1 million men underwent cosmetic surgery in 2007, a 9 percent increase from 2000. Of those procedures, 884,000 were minimally invasive such as Botox, microdermabrasion and laser hair removal, while 233,000 were surgical such as rhinoplasty, eyelid surgery and liposuction. Botox treatments are the most common minimally invasive treatment for men, with 296,012 done in 2007 — a 215 percent increase from 2000.

Anecdotal interviews of physicians at local hospital systems including Milwaukee-based Columbia St. Mary's and Aurora Health Care, Wauwatosa-based Froedtert Hospital and Glendale-based Wheaton Franciscan Health Care revealed local doctors are seeing more male patients too, especially those who are interested in Botox and eyelid surgery.

Last year, Lococo had Botox injections done at Froedtert & the Medical College of Wisconsin Plastic Surgery Center to soften his furrowed brow and above his eyes. The results were immediate, and he's setting up a second appointment. Lococo plans on having the same injections, and possibly a few more around his eyes.

He compares Botox to putting a toe in the water before deciding to jump in the pool. Depending on how he ages, Lococo said he would consider more complex cosmetic surgery.

One treatment of Botox costs an average of $2,000 and lasts about a year. Compared with the $8,000 to $10,000 for facelifts, Botox has become a popular and economically sound choice for many, said Dr. David Larson, chairman of plastic surgery at Froedtert & the Medical College of Wisconsin.

Dr. Jolene Andryk, a plastic surgeon with Aurora Advanced Healthcare, said despite the increase in male patients, she doesn't market her business to them because cosmetic surgery still carries a stigma for men.

Most of Andryk's male patients have been referred by wives or girlfriends, she said.

"I'm seeing more of the business professional group coming in," she said. "I (recently) had a consult with a man in his late-50s whose coworkers kept telling him he looked tired. He was looking for a more youthful, energetic appearance. There are subtle ways for men to look refreshed and refined in the business world and they are seeking them out."

Andryk, who does reconstructive surgery in addition to cosmetic, estimates 15 percent of her cosmetic base is men, up about 5 percent from five years ago.

Fourteen percent of Botox injections, 15 percent of all liposuction and eyelid surgeries, 20 percent of laser hair removal and 24 percent of nose jobs are carried out on men, according to the American Society of Aesthetic Plastic Surgery in Los Alamitos, Calif.

More patients

Larson has seen an increase similar to Andryk's in his male patient business as invasive procedures and so-called "liquid facelifts" become more popular.

Larson estimates about 10 percent to 12 percent of his business is male patients, making up 5 percent to 8 percent of his gross income.

"As word passes from their wives to them, I'm seeing more men," Larson said. "For invasive procedures such as liposuction, nose surgery and removal of excessive eyelid skin, men see great results and those operations have really gone up."

According to the American Society of Plastic Surgeons, the top five male cosmetic surgery procedures are nose reshaping, eyelid surgery, liposuction, breast reduction and hair transplantation. The top five minimally invasive procedures are Botox, microdermabrasion, laser hair removal, chemical peel and laser skin resurfacing.

Dr. Terrence Wilkins, a plastic surgeon with Columbia St. Mary's, said when he started 20 years ago, male patients were less than 10 percent of his business. Today, about two in 10 patients are men.

"The procedures men have are a little different here, than the national statistics," Wilkins said.

Wilkins said that nationally, the most common procedure for men is liposuction, but in the Milwaukee area eyelid surgery is the top procedure, followed by rhinoplasty.

Andryk said a man's professional status, income and education level normally coincide with his interest in plastic surgery. Cosmetic surgery is not typically covered by insurance companies.

"It's a sign of our times," she said. "Fifty is the new 30, so nobody wants to be 50 and look like they are 70."

Latino Immigrants to Europe Use Plastic Surgery to Fit In

File under self-hatred a lo Europeo. Plastic surgeons in Spain are reporting a barrage of requests from Central American and South American immigrants wanting to undergo plastic surgery to make themselves look "more European". According to doctors around 2500 immigrants submit themselves to procedures such as rhinoplasty (nose jobs) and other types of surgery to modify their faces.

"What they want is for people not to recognize them as foreigners and go unnoticed," explains plastic surgeon José María Palacín.

The surgery is said to cost around 5000 euros (around $7800) and 20 Minutos reports that the majority of immigrants that request the surgery are Ecuadorian and Colombians living in Madrid.

This is of course a terrible thing, but it also makes me stop and think: what is happening in Madrid that makes immigrants feel the need to go to these lengths to "go unnoticed"?

New Rhinoplasty Technique Preserves Ethnicity

Plastic surgeon, Dr. Oleh Slupchynskyj, has revealed in a new study that African Americans can have nose jobs without changing their ethnic look. According to a study recently published in the Archives of Plastic Surgery, a three-tiered surgical procedure can produce a natural-looking nose job without loss of racial identity. This procedure, Dr. Slupchynskyj states 'improves the equilibrium of the nose and face by reducing nasal flare, increasing the dorsal height of the nose and refines the look of the tip of the nose'.

 

Dr. Slupchynskyj noted that the three-tiered approach was significant since "African American patients are not looking to change their ethnic features; they seek satisfaction from a nose that is in harmony with the remainder of their facial features."

 

The study of 75 African American rhinoplasty patients found that most of them were satisfied with the result and indicated that their self-esteem was also increased.

GORE-TEX appears to be safe alternative for rhinoplasty

NEW YORK (Reuters Health) - For patients who undergo plastic surgery on the nose (rhinoplasty), GORE-TEX implants are a safe and inexpensive alternative to using tissue grafts taken from another part of the patient's body, according to the results of a 17-year review of more than 500 patients.

For initial and subsequent rhinoplasty procedures in patients with enough internal nasal tissue and external soft tissue coverage, "GORE-TEX should be strongly considered for major and minor corrections of the nasal wall and bridge in properly selected patients," Dr. Krzysztof Conrad and colleagues, from the University of Toronto, advise.

The review, which was conducted at a teaching hospital, community hospital, and private facial cosmetic surgery center, involved 521 patients who were followed for up to 17 years. A total of 685 GORE-TEX implants were placed, all by one surgeon.

The new findings appear in the Archives of Facial Plastic Surgery.

The implants, which were 1 to 10 mm thick, showed "excellent stability and tissue tolerance." Complications requiring implant removal developed in only 1.9 percent of patients and included infection, swelling, and cases in which the implant moved or partially came out.

"The unlimited supply and natural feel of the GORE-TEX implant," the authors comment, and the "excellent blending" with the contour of the nose, plus the minimal operating time, "outweigh the disadvantage of occasional complications, all of which can be treated successfully as long as they are not neglected," Conrad's team concludes.

SOURCE: Archives of Facial Plastic Surgery, July/August, 2008.

Allergan Smoothing Out Wrinkles

Allergan, Inc. (AGN) has been expanding into new therapeutic areas through acquisitions over the past few quarters. We believe these acquisitions will provide the company with the opportunity to drive growth in its existing business and to expand into new areas of business even in the face of slowing U.S. consumer spend. The Inamed acquisition, in particular, should help strengthen Allergan's position as a specialty pharmaceutical company.

From a fundamental standpoint, we are enthusiastic about the future of Allergan. The company possesses a strong blockbuster product in Botox wrinkle treatment and a slew of innovative new products in the eye and skin care markets. We were pleased to see Allergan receive the Food and Drug Administration approval for Juvederm dermal fillers several months ahead of expectations. Both Botox and Juvederm should help the company strengthen its position in the dermatology and plastic surgery market. We were also pleased to hear about the U.S. approval of silicone breast implants.

We expect 2008 to be a strong year for Allergan and the company's impressive pipeline should help drive growth in the next decade. The stock currently trades at 19.8x our 2008 estimate of $2.59. Several issues are likely to keep a lid on the share price in the near-term. Allergan shares have been under pressure lately due to safety concerns surrounding the use of Botox. Allergan also received a subpoena from the Department of Justice, U.S. Attorney's Office for the Northern District of Georgia, related to promotional, educational and other activities for Botox. We maintain a Hold rating on the stock with a price target of $56.

Male aging war waged on wrinkles, shrinkage

Is the man in your life showing his age a bit?

Now you certainly wouldn't want to tell him so directly, but some subtle ways can help him pull up his socks in the health and appearance departments. None of the problems addressed here are likely to kill, but they sure can be annoying.

Let's start with loose skin. Anybody who has been to a pool or locker-room has probably had to look away from old guys with flaps of pendulous skin. Droopy skin is not very nice on the face, either. It's caused by a slowdown in the production of collagen and elastin, as well as a decrease in the rate of shedding of dead skin cells.

Some skin aging is inevitable, but the American Academy of Dermatology's website, www.skincarephysicians.

com/agingskinnet/basicfacts.html, has some good tips.

Of course, it starts with avoiding sun exposure and smoking. But some of the cooler ideas include changing your sleeping position, since, as the site says, "resting your face on the pillow in the same way every night for years on end also leads to wrinkles."

The website notes "people who sleep on their backs do not develop these wrinkles, since their skin does not lie crumpled against the pillow."

The academy also advises us to stop doing facial exercises to maintain a youthful-looking appearance, because "repetitive facial movements actually lead to fine lines and wrinkles."

There, you've been warned.

Other sources, such as a website by author T. O'Donnell, who calls himself TigerTom, advise using a moisturizer after every wash to keep water next to your skin.

He also urges people to avoid cosmetic surgery because, "our perceptions of human beauty rely on very subtle clues in another's face: small lines, dimples, contours, expressions."

Letting a surgeon alter your looks brings the risk of becoming, as O'Donnell says, "a type, a Hollywood social X-ray, a waxen-faced thing."

Now maybe a little collagen shot or some Botox for dad's wrinkles wouldn't be too bad. It's all a matter of taste.

Another area where collagen is an issue is, well, just under the belt buckle. The loss of collagen can be a factor in reduced penile size and ability to hold blood in the penis, which is necessary for full erection.

Shrinkage can be a particular issue for men who have had prostate surgery.

Evidence published in the Journal of Urology showed some men experienced penile shrinkage after having prostate-removal surgery.

Overall, the study found "a slight decrease in the size of their flaccid and stretched penis."

And, for 20 per cent of the survey participants, the loss in penile length was around 15 per cent.

For most aging males, however, the problem isn't that the penis is getting smaller, it's that the surrounding area is getting fatter and obscuring the member. So, it's really an optical illusion. Well, that's a good story anyway.

The ultimate size-matters worry is a rare and bizarre condition called Koro, also known as penis panic. It's defined in a journal article as "a transient state of acute anxiety characterized by the triad of a deep-seated fear of penile shrinkage, its disappearance into the abdomen and apprehension regarding inevitable impotence or even death."

Cosmetic laser surgery reduces wrinkles by half, study suggests

The surgery, called carbon dioxide laser resurfacing, has previously been linked to side effects including scarring and acne.

But new research suggests that the treatment is safe and that after two years patients see an average 45 per cent reduction in the number of wrinkles and fine lines on their face.

It works by removing layers of damaged skin as well as stimulating the face to produce more collagen, the elastic material which helps give skin its shape, filling in the wrinkles.

Thousands of the procedures are carried out in the UK every year and can cost up to £4,000 to treat the full face.

The treatment is commonly used to remove fine lines and wrinkles from the whole face or can be used to target certain areas, such as crow's feet around the eyes.

It can also be used to tighten the skin, especially in the jowl area.

Researchers looked at 47 patients, with an average age of 52, who received the treatment between 1996 and 2004.

They found that while around half of the patients developed either acne or darkening of the skin as a result of the procedure most of the side effects had cleared up within two years.

At that stage the volunteers were measured according to an agreed score to determine the reduction in the number of wrinkles.

On average patients had 45 per cent fewer lines and wrinkles across all areas of their face than before the laser surgery, although some had up to 50 per cent fewer, the findings, published in the Archives of Facial Plastic Surgery journal, show.

Dr P Daniel Ward and Dr Shan Baker, from the University of Michigan, who carried out the research, said that their results proved that carbon dioxide laser resurfacing did lead to "long term improvements" in the reduction of wrinkles.

One third of all patients developed acne or small white cysts after the treatment, while 20 per cent experienced either lightening or darkening of the skin.

After two years just one case of darkened and six cases of lightened skin remained.

Patients who undergo the treatment can often go home the same day, although they are advised to stay out of the sun for at least a few weeks as their faces are left extremely susceptible to sun damage.

David Gault, consultant plastic surgeon at the Portland Hospital in London, said: "Carbon dioxide lasers are the gold standard treatment, with fantastic results."

Although different laser treatments had been designed in recent years to reduce the number of side effects, none have been as successful at tackling wrinkles, he added.

Running from wrinkles

Sitting around the coffee shop enjoying a post-long run recovery double-dose of caffeine a couple of Sundays back, the talk got around to somebody's new GPS device — and how it was so much better than the one it replaced.

"The satellite signal hardly cuts out at all when you're in the trees," Judy — the gizmo's owner said. "I think it's more accurate."

There was just one tiny issue, though. The old GPS clocked our usual down-and-back trail route at 22 K — the same distance as those old-style printed maps suggested. The new unit begged to differ. Just under 21, it claimed.

"Hmm," I said. "and does it say you look 30, too?"

Now 30 may be a bit of a memory for a lot us who invest a fair bit of time trying to distance ourselves from this mortality thing, I thought, while dodging a flying cup of hot joe. But it might not be that obvious if you looked at some of us - or anyone who exercises regularly. The signs of aging — while not absent — may be somewhat subdued.

Even so, every so often somebody will tell me they're still looking for an exercise routine that they can enjoy. "But not running, because that'll give me wrinkles and looking old before my time."

Well, it's not running — or any other form of exercise — that'll etch lines in your face. If anything, getting fit may help hold off the inevitable process of wrinkling as your skin conforms to a leaner, more muscular body.

However, yo-yo dieting may also wreak havoc with your skin as alternating between losing and gaining a lot of weight shrinks and then stretches your skin.

There are four major causes of wrinkles: age, exposure to ultraviolet light, smoking and repeated facial expressions.

The last three you can control by not basking unprotected in the sun, not smoking and not continually making the face that your mother warned you not to make when you were a kid.

There's still no cure for aging and its tendency to make your skin thinner, less elastic and more fragile. Your body produces fewer natural oils which will leave your skin drier and more wrinkled.

Sure, there are some things you can do to help lessen the effects of wrinkling. Aging boomers have spent billions on skin creams and botox injections in an attempt to turn back the clock.

But if you want to do it naturally, getting fitter is better, as long as you take the proper precautions for your skin before you head out for an hour-long bike ride or run on a sunny day.

Take a look at Paula Radcliffe, the world's fastest female marathoner. She's been running upwards of 160 kilometres a week training for the women's marathon in Beijing — eight months after giving birth to a daughter. Yes, she's got that typical rail-thin runner's body. But good luck finding a wrinkle on her.

5 ways to save face

Sunscreen

The most important face-saving product is sunscreen. One of the best is Anthelios with Mexoryl made by LaRoche, said Dr. Spencer Holmes, a Park Nicollet dermatologist. It's pricey ($30), but it lasts longer and protects against UVA (aging) and UVB (burning) rays. Still want that glow? Try spray-on tans, bronzers or self-tanners. Check out cosmetics guru Paula Begoun's top picks at www.beautypedia.com, which reviews more than 35,000 products ($25 annual fee).

Skin care regimen

A good skin-care regimen includes gentle cleansing, moisturizing, protecting and correcting, said Eagan dermatologist Dr. Charles Crutchfield. Try Cetaphil or Purpose cleanser and a fragrance-free moisturizer. For correction and protection, Retin A is still one of the best for reducing wrinkles, smoothing skin and stimulating collagen. Start with the generic Tretinoin, said Holmes, available by prescription for about 30 percent less than Retin A. Some patients experience redness, flaking and burning initially. Apply every other day or twice a week with moisturizer to reduce irritation. Begoun suggests moisturizers and exfoliants with alpha hydroxy or beta hydroxy acids and antioxidants.

Botox and fillers

Botox is the most powerful wrinkle reducer for the upper face, and fillers such as Restylan are best for the lower face, said Edina plastic surgeon Dr. Edward Szachowicz. For smoothing the forehead and crow's feet quickly, purified botulinium (Botox) reduces lines by blocking muscle contractions that cause wrinkles. It lasts about three to six months. Downside: Botox can cause bruising and swelling and persistent lumps. Cost: Doctors charge per unit, which runs about $12 to $17. A typical botox treatment is 30 units. Fillers run $500 to $1,200 per syringe.

Chemical peels

Acid solutions brushed on the face lift away upper layers of skin. The peels fade freckles, age spots and stimulate collagen. Weaker solutions of up to 12 percent can be done in salons or at home. A doctor's stronger solutions go up to 80 percent and while they are more effective, they are also more irritating to the skin, said Crutchfield, who charges $75 per peel for 12 peels over six months. The procedure can take 10 years off your face, he said. Downside: Can result in severe burns if not used properly. Results are not as immediate as a laser treatment. Cost: Some peels cost $250 or more per treatment.

Painless 'Botox' Cosmetic to Deal With Pesky Wrinkles

Painful botox jabs may well be thing of the past! Certain researchers have now invented a "botox cream" which pretty much does the same vanishing trick for wrinkles but with a lot less inconvenience.

Botulinum toxin or botox is injected by cosmetic surgeons to paralyze muscles and decrease the appearance of wrinkles, reports New Scientist.

However, this method can be painful and even cause tissue damage leading to problems such as drooping eyelids.

Now, Robert Nicolosi and Jonathon Edelson from the University of Massachussetts Lowell Nanomanufacturing Center have developed a skin cream that could help you get rid of the problem.

It had been thought that botox could not pass through the skin but the researchers have found that the toxin passes through with ease if it is attached to a nanoparticle in an emulsion.

They claim that the nanoemulsion also keeps the toxin stable, giving the cream a possible shelf life of up to two years.

Hollywood's beauty secret, out at last

As the fear of hard economic times infects, yes, even Hollywood, plastic surgeons and beauty consultants are pitching lower-cost alternatives to pricey face-lifts: Botox, lasers and all variety of creams, some of which reporter Shari Roan explored in one L.A. Times story on stem cell ingredients, and in another story on exotic botanicals.

Even a segment of the Daily Show once sent reporter Larry Wilmore to Beverly Hills to see how the rich and beautiful are coping, what with less wealth available to spend on beauty. He heard resident Goldy Anthony lament, "I haven't had Botox in 8 to 9 months," while Beverly Hills plastic surgeon Dr. Robert Kotler said, "I guess you can judge the economy by how many wrinkles are out there."

Now, according to a news release from Frownies Facial Pads, a Hollywood secret, kept under wraps since the product first came out in 1889, is out of the bag. The low-cost cosmetic treatment consists of craft paper with glue backing, called Wrinkle Eradicators in the 19th century, and still available under the new name. For about $20, customers get 144 of the sticky pads. You simply moisten the pad, stick it around the forehead, frown lines or crow's feet before bedtime, and wake up with skin that is smooth and youthful.

The trouble is, there are no scientific studies backing the face-taping process, which claims to retrain skin cells to be wrinkle-free, according to a site that reviews wrinkle creams. And of 66 people who took the time to write a review of the product on a website, some swear by the pads, while others say they're a waste of money.

But, with recession in the air, they are definitely cheaper than plastic surgery.

Massachusetts Plastic Surgery Center Receives Nationally Recognized Quality Seal

Last summer, board-certified facial plastic surgeon Dr. Frank Fechner moved his practice and surgical center into an elegant new location on Worcester's renowned Shrewsbury Street. The office-based plastic surgery center is distinguished by its superior quality and safety profile which is reflected in its recent 100% compliance with the Accreditation Association for Ambulatory Health Care (AAAHC) standards.

"We are proud of the AAAHC's recognition of our superior quality of care and state-of-the-art cosmetic surgery facility", stated Dr. Frank Fechner, the center's medical director. Dr. Fechner stressed his continued commitment for excellence in facial plastic surgery. "Having the AAAHC's seal of approval for our office-based surgery center after close examination of facility and procedures is a confirmation of our adherence to the strictest nationally-recognized health care standards."

The AAAHC is the premiere independent and non-profit organization that evaluates core health care standards such as quality of care, rights of patients and health records. In addition, adjunct standards that apply to organization's specific facial plastic surgery services have been evaluated. AAAHC focuses on hundreds core and adjunct standards related to anesthesia, medical and surgical services and Dr. Fechner's Surgery Center passed all these principles.

Dr. Fechner explains: "In order to ensure superior care, we wanted our office-based surgical facility to meet standards comparable to larger institution. Looking forward, I expect state and federal mandates to be passed requiring adherence to these high values in health care. We are proud to be one of the leaders in outpatient plastic surgery care."

Facial Plastic Surgeon Dr. Frank P. Fechner is Harvard-trained and double board certified with his private practice conveniently located in Worcester, Massachusetts. As a teacher at Harvard Medical School, he is affiliated with the Massachusetts Eye & Ear Infirmary in Boston and UMassMemorial Medical Center in Worcester, Massachusetts. A renowned facelift expert, he has been featured on ABC, NBC and other news outlets. Focusing exclusively on plastic face and neck surgery, in addition to eyelid and nasal surgery, Dr. Fechner performs hundreds facelifts a year.

Male Plastic Surgery

We'd all like to look like Brad Pitt or Denzel Washington; actually most of us wouldn't mind looking like any of the muscled and chiseled movie stars who have been deified in the mainstream media. Unfortunately, not all of us are blessed with mesomorphic builds, square jaws and granite abs. So we spend hours in the gym, guzzle magical bodybuilding shakes or simply throw in the towel and give up. But fret not, for modern medicine can slice, dice and sculpt your body into nearly any shape you can imagine. Breast reduction, liposuction, Botox, and a dazzling array of shape-enhancing implants are all within reach -- if you can afford them.

If you're thinking about surgical body modifications, keep reading. The following procedures can be performed in a matter of hours by a skilled plastic surgeon. But watch out, surgery has its risks.

Breast reduction

So you have a little extra fat on your chest or maybe you have full-fledged man boobs. Either way, you'd like a flat, smooth, manly chest. Breast-reduction surgery involves vacuuming out the fat and trimming excess skin to give you a flat, masculine chest. The procedure is called gynecomastia, which is also the name for the man-boob condition, and usually takes one to two hours to complete.

Risks: There are relatively few risks that result from this procedure. As with any surgery, bacterial infections are a possibility, but they're rare. You could also experience numbness in the nipples and surrounding areas, and the lack of sensation could be permanent or fleeting.

Costs: Breast reduction can be one of the most economical procedures. Surgeons typically charge between $1,500 and $3,000, depending on the length of the surgery and whether you have any pectoral implants installed.

Implants

You've spent months at the gym, but your chest is still concave and puny. And no matter how much time you devote to your calves, your legs are as scrawny as saplings. But don't worry, pectoral, calf, abdominal, and even butt implants can give you the appearance of an iron-pumping gym rat in a matter of hours. Implants are typically made of silicone or a malleable plastic that's meant to mimic firm muscle, and are inserted into the desired area through a small incision that's about an inch long. Each implant surgery usually lasts between one and two hours per area.

Risks: Again, infection is a risk. Swelling and tightness around the implant are common and recovery times range from one to two weeks. Although implants may be permanent, they can drift and cause an asymmetrical appearance.

Costs: Implants are a bit more time-consuming than breast reduction or liposuction. As a result, expect to pay between $2,000 and $5,000 for an implant.

Going under the knife could mean a simple injection or a vacuuming event…

Is all this plastic surgery about demons within?

In the 1989 movie Batman, Jack Nicholson's Joker tricks Gotham City by making its public figures look like him, with grotesque upturned mouths, bleached and oddly fattened faces.

At the time, this was a shocking practical joke and was featured in Vanity Fair as a playful, creepy teaser for the film.

The intrepid National Enquirer, abandoning beach cellulite and loose bellies for the interim, last week published a series of "PLASTIC SURGERY SHOCKERS" that gives evidence, page after page, of the Joker's future being now.

We all know too well the freaks of surgery.

There is Cher, who was on the knife vanguard decades ago, and her taut mask; Michael Jackson's pathological makeover, which has resulted in his looking as if he should be carrying a warning sign ("People with heart disorders, and pregnant ladies are advised not to gaze upon the face of horror!); and socialite Jocelyn Wildenstein, the Cat Woman who looks like a stray monster on kitty death row.

But what of the allegedly normal stars, who have taken up the many splendours cosmetic surgery has to offer?

A fan of surgery and injectables, I am still startled by stars with enough money to achieve glam perfection who wind up looking like deformed incubi and succubi. Is this kind of surgery the new expression of those "demons" that celebrities always allude to during in-depth interviews? I have never read an interview with even the mildest Hollywood transgressor who has not mentioned such devils and always wonder what gives them the audacity to evoke bleak, killing creatures who haunt civilians to murder, suicide and worse.

I blame Method Acting, a school of thought that lends credence to the idea that everyone is plagued by internal torture, torture that, when summoned, lends heft to roles in films such as Saving Private Ryan or Forrest Gump.

The fact of the matter is that while we have all experienced pain in our lives, true, nauseous agony remains the purview of the ill, people who are so damaged they could not audition for a voice-over ad for Bistro Express, let alone a major motion picture.

Authentically mad people are not capable of the high level of function involved in trying out for "Badass Cop 3" on Law & Order, yet actors have long delighted in fabricating a past and present that support their psychic otherness, usually manifest in the form of their playing a disco coke dealer, or super-angry parent, or angrier transgender hula-hoop contestant.

If the idea of injecting toxins in one's face was once shocking, so was the notion of simply being photogenically blessed and beautifully vain, dumb and smart enough to do whatever was necessary to land the part that created award buzz. In the now-distant past, stars did not credit their performances to abuse, neglect or a wicked-bad time living in pool-less hovels. These great stars also never pretended that they were losers in high school because they were so tall and pretty ("I was called Skinny-Ass! And that hurt!). In the past, many of these stars had genuinely suffered, something they took great pains to hide, as the road to fame was littered with personal disgraces, as in the infamous "casting couch," that they were desperate to leave behind like so much vulgar baggage.

It is popular now to admit to one's usually fraudulent hard times. Soul-destroyingly beautiful stars will tell you that they felt really awkward as youths; that their radiant beauty is somehow an accident of their viewer's discerning nature. Not so long ago, supermodel and actress Paulina Porizkova was on Late Night with David Letterman, openly mocking her derisive childhood friends she left behind in Czechoslovakia as "potato peelers," secure in her knowledge that she was goddess enough to transcend her past.

Now, stars embrace these dubious psychological injuries with causes as fatuous as "I had freckles!" or "I wore plaid," and much of their seeming addiction to plastic surgery confirms not only the desperation stars feel to stay young and beautiful - even Paul Newman was not immune to this and grew to detest what were, for all intents and purposes, his crumbling looks - but also their deeper-rooted desire to assert their tragic difference.

Yes, some stars have surgery for normal reasons and that is awesome: How else can a 45-year-old Demi Moore hang onto a man more suited for her daughters?

Others, however, seem to making a statement with their surgeries. For example, dead-but-for-the-burying Lara Flynn Boyle, who has long prided herself for a radical thin chic that actually worked, even if it made one wince, has made a fatso of her face as if to say: Jack Nicholson! Bring me to a Lakers game now! Madonna, in the midst of her midlife crisis, has skinned herself to a skeleton while, through a variety of injectables, making an obese mockery of her own face: One is tempted to call this more of her shape-shifting, when it feels, more genuinely, like a cry for help, and for yet another Latino sports star who loves her deep down.

Donatella Versace, on the other hand, is a muffled scream for help: Her face now resembles the bloated corpse-head of a woman left to decompose in her squalor. Similarly, and very sadly, Heather Locklear, always a trashy beauty, is a creature I like to call a "Puffalope:" all rack and bone and chubby, inflated, false-joyous head.

The Enquirer presents this macabre gallery of surgical changelings without comment, and readers are left to speculate about the region beyond vanity; that is, the subcutaneous reasons behind profound and disquieting transformation.

We must speculate, also, if these same stars are seeing through the naive eyes of The Graduate's Benjamin Braddock and observing, terribly, "I see opportunity in plastic."

*****

7 days, 5 things

1. Now it's Angelina's turn to cry

Always an answer song, Jennifer Aniston, still riding in the slipstream of her ex-husband's now-ancient betrayal and currently dating the sexually suspect John Meyer (professional hairdo and Perez Hilton kisser), is on the cover of the Star this week, beside the headline "Now It's My Turn!" For what? On the bright side, Hairdo is said to be obsessed with Aniston's first major film role in Leprechaun (1993), which he screens daily, to her consternation.

2. A novel with a key and a crowbar

In her new roman à clef, American Wife, Prep author Curtis Sittenfeld abandons her obsession with "Kissing and Kissing" rich boys and (as in Jackie Susann's Dolores, a scarcely veiled portrait of Jackie O) creates a thinly disguised portrait of Laura Bush. "You gave him power," one excerpt in the heroine's voice reads. Pretty soon, you won't have Bush to kick around any more.

3. YouTube week

Watching "Christian the Lion," set to a variety of tear-jerking songs, and reels of the late, great Bernie Mac riffing on his inherited (from his sister) satanic children are the pop highlights of the week.

4. I swear she felt like a very late swim!

Robert Wagner has completed his memoirs, Pieces of My Heart, and an excerpt about his wife Natalie Wood's extremely suspicious death by drowning in 1981 has been published. Notoriously terrified of water and having, as a guest on the yacht The Splendor, her apparent lover Chris Walken, Wood is still said to have decided to play with a dinghy in the middle of the night while her husband and sweetheart duked it out. Did she also scream, "You're tearing me apart!" as she made her last rebellious, fishy dive?

5. Michael Jackson was not credited for the same bold fashion move

In the new Vanity Fair's International Best Dressed List, in addition to such crazed admissions as Fran Lebowitz and Morley Safer, Julian Schnabel makes an appearance in the following atrocity: "Dark-purple pyjamas with white piping," sneakers and a billowing overcoat "typically cinched ... with a multicoloured scarf."L.C.

Clinical trials offer free plastic surgery

Given the weakened economy, many Americans interested in cosmetic procedures have had to nip and tuck the amount of money they spend.

"I would love to look like I was 25 again," said Jodi Richfield, who has children in private school. "But your kids need to go to school and they need to eat."

The 43-year-old Joelton woman recently found a way to receive such luxury treatments free. She underwent a "facial resurfacing" procedure - it typically costs $3,500 - to remove sunspots and fine wrinkles from her face, by participating in a study at the Nashville Centre for Laser and Facial Surgery.

Richfield said the study was an opportunity to receive pampering that she couldn't otherwise afford. And she's not alone: 53 percent of plastic surgeons report business has slowed, according to a recent survey by the American Society for Aesthetic Plastic Surgery.

Government health officials urge those who enroll in studies not to have high expectations.

"People should understand that what they are participating in is research, not treatment," said Dave Banks with the FDA's Office of Special Health Issues. "In research, the goal is to generate new knowledge using patients."

Besides facial resurfacing, the Nashville Centre for Laser and Facial Surgery is conducting clinical studies in the following areas: hair removal from the upper lip, eyelid skin tightening and lessening eyelid wrinkles.

Cosmetic procedures being offered through the studies would typically range in price from $1,000 for hair removal to $3,500 for facial resurfacing.

People who enroll get the treatments free and in the case of the hair-removal study can receive up to $800.

No guarantees

While the price is right, Dr. Brian Biesman, who is conducting the clinical trials, stressed that he can't guarantee the results will be as good or better than comparable treatments already on the market.

"That's what we are trying to find out," said Biesman, who is president of the American Society for Laser Medicine and Surgery.

The treatments have been deemed to be safe by an institutional review board, though. Such boards are composed of scientists, doctors and lay people who review studies to make sure that participants aren't exposed to unreasonable risks.

The Office for Human Research Protections in the U.S. Department of Health and Human Services advises people to ask the following questions in making their decision to participate in clinical trials: What will happen to me in the research? Will the research help me personally? What other options do I have? Can I leave the study at any time? Will it cost me anything personally? Will there be any unpleasant side effects?

Biesman said all such cosmetic procedures carry some risk of scarring, blistering and lightening or darkening of the skin. Richfield said she looked as if she had a bad sunburn for a few days and her eyes swelled up.

For her, the sunburn was worth it.

"I had a lady at the mall come up to me and say, 'You have such beautiful skin,' " Richfield said. "I have never had anyone say that to me before. I was freckly. I almost cried."