Celebrity Plastic Surgery, News, Gossip

By Leonard M. Hochstein, MD

The perfect breast augmentation begins by choosing the right plastic surgeon. I think by now everyone understands board certification and some of the fake boards that are out so I will not dwell on these issues, but talk about more specifics as I have seen in my experience.

I believe that the perfect result is a surgeon’s combination of talent and experience. There is no question of some surgeons’ ability to make asymmetric breasts look beautiful while others falter. Much of this is as a result of experience while seeing every type of breast that there is. There is no question that my skill improved with my experience. This translates into few insights for the patient. It is hard to find a talented young surgeon, so go for the proven one with the necessary experience to get the job done. Unless you are in the major market, it is unlikely you will find a surgeon who does 500 breast augmentation surgeries annually like I do. So what number is considered good? I would say at least 150 breast augmentation procedures annually is sufficient. This means that the surgeon is doing about 3 breast augmentation procedures on a weekly basis. Make sure to see plenty of pictures of their results. There should be good consistency there. Be wary of surgeons who will only have a few pictures to show you. You should be able to look at books that include hundreds of patients.

The next factor to consider is the site of surgery and the anesthesia provider. There are four options for setting. I would suggest either a private, accredited surgical center which is my preference or an outpatient ambulatory surgery facility. The other two options are a non-accredited private facility or hospital. I would avoid the former because there is no quality control standards and the latter because hospitals are dirty environments with infection risk being unacceptable for my standards.

If there is a problem in the surgery, it is generally anesthesia-related, but it seems few patients asked me about who will be putting them to sleep. There are two options here. The first is a board-certified anesthesiologist and the next option is a CRNA or nurse anesthetist. I use Dr. Livschultz, a medical doctor who is a board-certified anesthesiologist. He has been working in my office for the last 2-1/2 years full time. This familiarity allows us to offer the safest experience for my patients. Most doctors, because of their inconsistency, book their anesthesia provider based on availability which puts you at the mercy of the anesthesiologist who is available on that day. This relationship fosters unfamiliarity and inconsistency. I have a very close relationship with my anesthesiologist where we are able to discuss any pitfalls and make adjustments. For example, we recently came up with a protocol of providing totally intravenous anesthesia or TIVA for first time patients thereby avoiding any risk of malignant hyperthermia. Using a nurse (CRNA) is also frequently used, but not in my practice. In this situation, the physician is overseeing the anesthesia and since I am not trained in this field, I do not believe I am qualified to do so. Be aware of this because it is a cost cutting maneuver; go for the physician anesthesiologist instead.

Now that you have picked your physician, it is time to decide on the type of implant, the incision, and the size. I am not going to talk too much about placement as implant should always be placed submuscularly and if you have chosen a competent surgeon I will assume that is their preferred placement. I am not aware of any experienced breast surgeon who would put the implants above the muscle or in a subglandular location. There are two types of implants available, saline or silicone. The shells in both are made of silicone. They only differ in that saline implants have a balance that they can be inflated once they are positioned. The shells are smooth or textured. Texturing is a process where smooth implants are given a rougher feel. The idea here is to decrease the risk of capsular contraction. The downside is that by making the shell thicker, it also raises the risk of rippling or wrinkling. I do not use textured implants unless there is a significant risk or history of contracture. In this situation, they are indispensable. The main difference is what the implants are filled with. One is filled with saline solution and the other with silicone gel. There are subcategories of each. They come in round or teardrop and the silicone also varies in level of cohesiveness. I prefer the round because they allow for better cleavage and more fullness superiority, but mainly because the teardrop implants tend to shift, which can create an unnatural appearance. I also prefer silicone as they feel much more like breast tissue and have much less wrinkling or rippling than do the saline counterparts. All silicone implants today are cohesive, meaning the silicone will maintain its shape even if there is a defect in the integrity of the shell. But there are now 2 levels of cohesiveness, namely Level 1 and Level 2. The Level 1 implants which are currently used in the United States are semi-liquid whereas level 2 (gummy bear) are semi-solid. The level 2 implants, which come in teardrop shape only are currently unavailable in the United States as the study is now over (there is a prominent plastic surgeon in the Los Angeles area who advertises that he is still using these implants which is not true, so do not be fooled). I have had the opportunity to work with some of these level 2 implants and have found them to be unsatisfactory for two reasons. The first is that they are too firm and also require a very large incision or scar to place as they are not malleable and cannot be bent to place requiring the opening to be almost as wide as the implant itself. This also limits access to the inframammary fold. I believe these implants may have a role for reconstruction in the future, but for aesthetic purposes, I prefer the level 1’s. I still see hesitance towards silicone implants due to safety issues or leak detention. But these concerns are unwarranted. Silicone implants were taken off from the market in 1991, not because they were found to be unsafe, but rather because the FDA deemed them to be inadequately studied. Since that time, there have been multiple studies which have unequivocally found them to be safe and without any links to autoimmune diseases. Simply, the women who developed these illnesses would have developed them whether they had implants or not. The other issue I regularly hear about is the risk of deflation and its treatment. Over the course of 7 years, the deflation rate for saline implants is 15% whereas for silicone it is only 2%; thus making silicone more durable. If there should be a leak, it is much easier to diagnose the saline implants as they simply go flat.

Silicone cannot be diagnosed by physical exam, but rather requires an MRI. The treatment for each is much different since the shape or volume of a silicone implant does not change, it is very easy to replace and could be done simply under local anesthesia. Saline implants are much more difficult to replace as the capsule begins to contract immediately after deflation. This is much harder and requires a general anesthetic with reconstruction of the pocket. I use Mentor implants, as I believe they are the best implant available in the market and currently they come with a lifetime warranty.

There are several access points for implant placement including transaxillary, periareolar, inframammary fold, and transumbilical. All these access points are available for saline implants but limited to periareolar or inframammary fold for silicone. I prefer the periareolar approach because the scars tend to heal better and are less visible when wearing a bathing suit. It also allows direct access to the inferior insertion of the pectoralis major muscle, the proper release of which is crucial to perfect placement.

The last discussion is the size of the implant and the profile, low, medium, or high. When I determine the implant size I begin by talking about the patient’s desired cup. I need to stress that this is only a starting point of the discussion as I do not create a cup size, but rather a look. We decide this by looking at some of my postoperative pictures, as well as having the patient bring in pictures of looks they like and then trying on an implant. Trying on an implant is more useful in smaller breasted women and less so in women who have more breast tissue or are in need of a lift as well. When the patient likes the look of an implant on her chest, I add 50 cc to it and that is the volume I use in the submuscular location. There is no perfect way of picking the size, but this has worked well for me. As a bit of final advice, if you are between 2 sizes, go for the larger one and do not listen to your friend’s advice. They are not you, do not know what you want, nor do they necessarily have your best interest at heart. If there is ever a regret it is that patients did not go bigger. I rarely hear that they are too big.

I choose the profile depending on the patient’s desired size and chest width. The three profiles are moderate(low), moderate plus(medium), and high(high). I typically use the moderate plus because it gives the best combination of projection, which gives a more defined cleavage, and enough width of diameter to avoid cleavage separation. For my patients who have narrow chests or wish to have a large cup size I choose the high profile implant. I rarely use the low profile implant as the only indication is for models who wish to have a very small augmentation and need the greatest diameter width as possible to avoid cleavage separation.

The recovery period is less than a week. Most of my patients are able to drive on the fifth day and return to work after one week as long as no heavy lifting is required. I allow my patients to reach above their head as long as they are not stretching to reach a distant object. I allow aerobic workouts as long as they limit to lower body after 4 weeks and full gym workouts after 6 weeks. I do have patients perform massaging exercises to stretch the muscle in the medial location by squeezing the implants together. This also helps for settling which is usually a 4-month process and rarely can take longer. I also recommend that a moisturizer be used on the incision after 3 weeks of healing and on the breast itself immediately after surgery. Scars do not create moisture on their own and they need help.

Breast implant maintenance is a topic which seems to be misunderstood. The biggest misconception is that implants should be replaced every ten years. This is simply not true and came about based on the data that the old (prior to 1991) silicone implants had a significant leak rate after 10 years. By mistake this has been extrapolated to the current saline and silicone implants used today. The current silicone implants made by Mentor are warrantied for life and require replacement only if a defect should develop. This is the same case for saline implants which are currently warrantied for 10 years (extended warranty is available for purchase from Mentor). Simply put, if there is no problem precautionary replacement is not required.

The horizon shows a few things of promise. Stem cells may one day be used for breast surgery. Their potential seems limitless. I am just beginning to work with them and will see what applications develop.

There is no question that I have some very strong opinions on breast augmentation. These opinions have been formed over many years and many augmentations. I sincerely hope my ideas will be of help to anyone interested in this wonderful operation.

Ask Dr. Leonard M. Hochstein Questions & Get Answers

Click here to ask Dr. Hochstein Questions Live & Get Answers

Dr. Hochstein has his own message board on Make Me Heal where he answers facial plastic surgery questions live from patients.

About Dr. Hochstein:

Dr. Hochstein, or Dr. H as he is known as, began his medical career when he applied to medical school as a merit scholar high school senior. He was able to surpass the customary four years of college and go directly from high school into medical school. The first in a long list of exceptional achievements to be obtained during his academic and surgical training. He attended the accelerated program at the Louisiana State University Medical Center where he graduated as Valedictorian of his class. It was during his time in medical school that Dr. H worked closely with the Department of Surgery and had his first scientific paper published. He received his M.D. in 1990.

Learn More about Dr. Leonard Hochstein

Dr. Hochstein’s Website: http://www.lhochsteinmd.com

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If you’ve ever wondered what a celebrity dermatologist has to offer, meeting Beverly Hills-based Dr. Stuart Kaplan makes you understand. In this intimate interview, Dr. Kaplan tells Make Me Heal about some of the treatments, beauty secrets, and skin care tips that have made him the go-to cosmetic dermatologist for film, music, and television stars.

Make Me Heal: With all the available choices for dermal fillers, which ones do you think work best for the various areas of the face.

Dr. Kaplan: It is important to understand the difference between Botox, a muscle relaxer, and Juvederm, Restylane, Collagen, etc. which are fillers.

The easiest way to visualize the difference is to think of a crease as a valley between two mountains. Botox prevents the mountains from being pushed together, and fillers fill in the valley.

If someone has a crease that is apparent only when frowning or squinting, Botox should be all that is necessary. Botox is most often used on the forehead, crow’s feet, and frown lines. It can also be used to treat neck bands. (Its most recent FDA approval is for armpit sweating and sweaty hands. For these conditions, results can last 6 months or longer.) Botox works on creases in two ways. First, it weakens the muscles that cause the creases. Second, and even more important, as the muscles get weaker, the patient gets out of the habit of creasing and using those muscles. In this way, Botox actually prevents the progression and deepening of creases.

Now, as we get older, our creases also age. They become deeper and deeper, even when we are not frowning, squinting, or using facial muscles. If creases are only apparent when we squint, only Botox is needed. If creases are visible at rest, and not made worse by squinting, then fillers are necessary. If creases are present at rest, and get worse with facial expressions, then Botox AND fillers will be necessary.

Here is my summary on Injectable Wrinkle Fillers:

The differences between fillers has to do with thickness and longevity. In general, the thicker the filler, the better it will fill creases, but the greater the chance of possible bumps. Bumps are more likely in thinner skin such as the lower eyelids, and crow’s feet. Zyderm (a type of Collagen), and Restylane Fine Line are the least thick and can be used around the eyes, but they are also the shortest lasting. Juvederm Ultra Plus is one of the longer lasting hyaluronic acid fillers. It can be used for deeper creases. Juvederm Ultra Plus can last between 3 and 6 months.

Fillers can also be used to improve or enhance facial structures such as:

• Filling in acne scars

• Enhancing cheek bones to make them fuller and more defined

• Enlarging lips for a fuller, softer pout

• Correcting lip deformities or asymmetry

• Non-surgical nose-job to fill in dips and valleys in the nose bridge

• Filling in hollows under the eyes that contribute to dark circles

Other new trends and uses of fillers include:

* Rejuvenation of the tops of hands (as we age, our skin thins, and the tops of our hands look “veiny” and boney. Adding a filler material creates a layer of filler that plumps the skin on the tops of our hands, and makes our hands look younger.

* Nipple enhancement

*Vaginal rejuvenation

* Injecting into the soles of the feet to make wearing high heeled shoes more comfortable

Four other fillers deserve mention:

Radiesse is considered the longest lasting filler, It is made from a similar material that bone is made from. Although it is not permanent, it can last up to one year in many cases. It is ideal for the nasolabial folds that get deeper as we get older. It is also my treatment of choice for hand rejuvenation. When combined with laser, the laser improves the discoloration on the surface of the hands, while the Radiesse plumps and thickens the skin, making our hands look more youthful and vibrant.

Sculptra is a volumizer, and fills larger areas of the face, such as sunken cheeks. It is FDA approved for treating fat atrophy in HIV patients, but is also useful for cosmetic improvements in all patients. It requires several treatments, each about one month apart. While still classified as an injectable filler, its effect is more like a tissue expander, increasing volume and filling in larger areas. Imagine a balloon gently being blown up under the skin. It is not a balloon of course. It is made from the same material that dissolvable sutures are made, and is not permanent. After several treatments, results can last 1 – 2 years.

Silikon 2000 (Silicone) and Artefill (polymethyl methacrylate aka PMMA) are permanent synthetic products that the body cannot metabolize or remove. While they have unique benefits, they also have unique risks in that once injected, they are permanent, and cannot be removed.

Make Me Heal: There are many lasers to choose from today like Fraxel, Active Fx, Palomar’s Starluxe, CoolTouch, and many others. Which laser do you like to use for facial rejuvenation and wrinkle reduction?

Dr. Kaplan: I use the state-of-the-art Sciton Laser, which has various wavelengths for Skin Tightening, Pore Refinement, Redness and Pigmentation. Because many lasers can be used to combine and overlap treatments, I believe the Sciton produces superior, unparalleled results.

Make Me Heal: What do you think are the best temporary fillers for augmenting lips?

Dr. Kaplan: There are many different injectable fillers on the market today, and most of them can be used to shape and augment the lips. It is important to understand that every product is different, and has it own unique advantages and disadvantages.

For the best results, the right product needs to be matched for each individual patient. Successful outcomes also depend on you choosing an experienced doctor with excellent injection techniques. Based on my personal experience, the perfect lip is the one that “wows” the patient and makes them happy with the procedure. Everyone is unique, and a reputable, capable doctor will approach each face individually to give the best possible cosmetic result.

Here is a brief overview of the most popular fillers:

Radiesse – a calcium based injectable filler, which is considered the longest lasting (may last a year or more). While not used for the lips, Radiesse works especially well in the nasolabial folds, the lines that run diagonally from the outer corners of the mouth to the nose.

>>>Cost: $1,000 per 1.3 cc syringe. Most times, only one syringe needed, but for deeper creases, and depending on the outcome you desire, you may need more than 1 syringe.

Hyaluronic Acids – brand names include Restylane, Perlane, Juvederm Ultra, and Juvederm Ultra Plus. While acting as a filler, these agents also bind to water to keep skin molecules plump. The filler itself is soft and pliable, giving you a smoother, more natural result. No pretreatment or allergy testing is necessary. Restylane works best for medium wrinkles and lasts about six months. Juvederm Ultra can be used for fine lines, while Juvederm Ultra Plus works better for medium-to-deep wrinkles and folds, and can last up to nine months.

>>>Cost: $500 - $600 for each syringe.

Collagen – brand names include Zyderm and Zyplast. Because collagen is obtained from the skin of cows, and a small percentage of the population is allergic to bovine collagen, you must have an allergy test done first. Zyderm is best for superficial wrinkles. Zyplast is better for deeper wrinkles, furrows, deep scars and lips. It lasts three to six months.

>>>Cost: Collagen injections cost about $250 to $300 per 1 cc, and depends on which material is being injected. The allergy test costs an additional $75.

Additional considerations before going in for your cosmetic injections

1) Inquire about the doctor’s skill and experience with the particular filler. Also, does the doctor do the injections or does a nurse or assistant? In my practice, I do all the injections, as I feel that an assistant can never substitute for 20 years of experience.

2) Different fillers have different benefits and risks, and depend largely on a person’s facial features as well as personal preference. Your doctor should evaluate your needs and recommend the best filler for you.

3) Remember, what looks great on your friend, may not always be the best fit for you.

4) Different fillers come in different sizes. For example, Radiesse comes in a 1.3 cc syringe, while Juvederm comes in a 0.8 cc syringe. Your cost will be based on how many syringes you need to achieve your desired result. Keep in mind you may need more than 1 syringe.

Make Me Heal: Do you use any permanent facial fillers? If so, when do you recommend using them?

Dr. Kaplan: No, I do not. The skin on our face continues to age and thin, as we get older. Creating a certain skin plumpness today may ultimately become elevated years from now when our skin gets thinner.

Make Me Heal: We know that you have celebrity clients and that you treat some of them in preparation for the Oscars. What are the most requested procedures from clients walking down the red carpet?

Dr. Kaplan: Cosmetic procedures with little down time are popular during award season. Particularly

1. Botox injections to the underarms and palms, to prevent underarm sweating and sweaty handshakes. This is beneficial since anti-perspirants can leave a white residue, discolor clothing, or irriate the skin, especially when used after shaving the underarms.

2. Injectable fillers for deep creases or to give lips a more youthful pout. There is an art to injecting just the right amount of material to give a very natural result. The worse outcome is an obvious “something-was-done” look.

3. Other popular procedures include a laser skin peels, which gives skin an even skin tone and freshness, and skin tightening laser, to tone and tighten skin around the thighs, upper arms, neck and stomach.

4. Laser treatments for facial blood vessels, which are difficult to cover with make up.

5. Sclerotherapy for leg veins, especially when wearing short dresses that show a woman’s legs.

Make Me Heal: What celebrities have you treated and for what?

Dr. Kaplan: It is against medical ethics to disclose patient information. However, I can say I have treated dozens of Oscar, Grammy, Emmy, and Tony Award winners.

Make Me Heal: What are the best non-surgical preventive steps to keep the skin from aging?

Dr. Kaplan: Stay out of the sun, wear sunscreen even on overcast days (since 85% of UV rays still filter thru the clouds), and stick to a dermatologist recommended skincare regimen. Do not use overly drying cleansers or toners, always use a moisturizer with an SPF during the day, and use a nighttime skin repair product at night. I also recommend using a mask 2-3 times a week, and using a non-abrasive exfoliant on days you do not apply the mask. And of course, please remember to use an SPF on the lips. A lot of these lip glosses and lipsticks contain castor oil or petroleum jelly as the main ingredient. This acts like cooking oil on the lips when you step outside. One of the first noticeably signs of skin aging is wrinkles around the eyes and lips.

Make Me Heal: What are the new innovations in treating acne?

Dr. Kaplan: The use of Photo-Dynamic Therapy, using Levulan and multiple laser wavelengths. I have seen incredible results using this treatment. It is an excellent alternative to Accutane, requires fewer visits, and is less expensive.

Make Me Heal: What do you think of acne clearing home devices such as Zeno, Tanda, and the Marvel Mini?

Dr. Kaplan: I do see patients that have tried these products. However, if I am seeing these patients, they are coming to me because these products have not worked. When a product works, the patient does not need to come to me.

Make Me Heal: How can you rejuvenate the appearance of aging hands?

Dr. Kaplan: Radiesse can be used to plump the hollows between the bones in the hands. It is a quick, easy outpatient procedure, that takes less than 15 minutes. Also, Laser can be used to remove age spots and freckles on the hand, as well as smooth uneven skin texture.

Make Me Heal: What are the best way to get rid of spider and varicose veins? Please discuss the lasers you use, how the procedure is done, pain involved, and whether the changes are permanent.

Dr. Kaplan: It depends on the thickness of the vein. Spider veins can be removed very easily with the Sciton Laser. The pain can be likened to a rubber band snapped against the skin. For larger varicose veins, a solution is injected directly into the vein to push out the blood trapped in the vein and allows the vein to collapse onto itself. Results are long lasting. However, the longevity of the result is determined by the patient’s activities, such as standing for long periods, crossing their legs for long periods, etc.

Make Me Heal: What are you using today to remove brown and age spots? Please discuss the procedures you use, how the procedure is done, pain involved, and whether the changes are permanent.

Dr. Kaplan: I use a laser to remove brown and age spots, as well as freckles. Popular areas to treat include the face, forearms and décolleté. The pain can be likened to a rubber band snapped against the skin, repeatedly. The procedure is relatively quick, with very little downtime. Patients do experience some redness, but that disappears in a few days. As far as the results, they are long lasting, but again, they depend on the patient’s activities. Wearing sunscreen, even on overcast days, and staying out of the sun altogether, will keep the results more or less permanent.

Make Me Heal: Do you surgically treat people with skin cancer? What are the current best treatments now for the disease?

Dr. Kaplan: I perform Mohs Skin Cancer Surgery to remove Squamous Cell Carcinoma and Basal Cell Carcinomas. Mohs surgery involves using a microscope to check the edges of the tissue after it has been removed. If any skin cancer remains, that area can be re-excised at the time of the visit. Mohs Surgery gives the highest rates of cure available for removing skin cancers. The procedure is done in my office using local anesthesia.

Make Me Heal: You have your own skincare line called KaplanMD. What is the philosophy and technology behind the line?

Dr. Kaplan: The concept of the kaplanMD line is “10-3-1” : 10 active ingredients per product, to prevent and treat all 3 types of skin aging, in 1 concise line.

Most skincare products today focus only on 2 types of skin aging: Chronologic Aging and Sun Damage. Yet, many skin symptoms are in fact result of a third type of skin aging, which has never been addressed by a skincare line: Skin Aging due to hormonal imbalances.

It is important to understand that Hormones are what maintain and regulate the production of Collagen, Hyaluronic Acid, and Elastic Tissue. Collagen is what gives skin its strength, structure and plumpness. Hyaluronic Acid keeps our skin moist, plump and hydrated. And Elastic Tissue is what gives our skin its elasticity, or youthful ‘bounce-back’ quality. All 3 components are vital for healthy, youthful looking skin.

Only kaplanMD Skincare was created to help prevent and treat all 3 types of skin aging in one convenient line. Each product contains no less than 10 active ingredients, including an exclusive Phytogenic Triactive Complex of Soy, to firm and plump skin, Grapeseed Extract, to combat free-radicals, and exotic Black Cohosh, to help balance and relieve skin symptoms.

These ingredients are then delivered deep within the skin using a patented Time-Release Microsphere Delivery System, previously found only in prescription medications.

The result is healthy, radiant and glowing skin—for life.

Make Me Heal: What do you think differentiates KaplanMD apart from the myriad of skin care brands on the market?

Dr. Kaplan: I created kaplanMD as a complete balanced diet for the skin. Most skincare lines on the market today only address anti-aging or sun damage. But there is a third type of skin aging, caused by hormonal imbalances in both men and women, which starts in our late 20s and early 30s. This is a revolutionary new concept in skincare, and kaplanMD is the only skincare line specifically formulated to meet all these needs.

But to put it simply, kaplanMD Skincare has 5 points of difference from anything else on the market today.

They are:

1) Formulated using a unique “10-3-1” Concept : Ten active ingredients per product, working synergistically to prevent and treat all 3 types of skin aging, in one concise line.

2) Exclusive Phytogenic Triactive Complex of Soy, Grapeseed, and Black Cohosh in every kaplanMD product.

3) Patented, Time-Release Microsphere Delivery System for maximum efficacy.

4) Concept of the Vehicle: kaplanMD gives the benefit of a dozen ingredients in one convenient, effective application.

5) Concept of multi-patented ingredients to treat one symptom ~ Maximizes benefits with minimal irritation.

Make Me Heal: If someone were to buy your products, how do you suggest they use them in a daily regimen for normal, oily, or dry skin.

Dr. Kaplan: The kaplanMD product line was created to prevent and treat the 3 types of skin aging, which is independent of the oily vs. normal vs. dry skin hype created by the industry for marketing purposes. I believe that skin, regardless of ethnicity and skin type, experience the same skin symptoms as we all age. By using a potent combination of botanicals and peptides, we can prevent some of these skin symptoms from occurring, and help slow the skin aging process.

Make Me Heal: What are your top skincare tips for the summer?

Dr Kaplan: Most people know that using sunscreen protection is essential for healthy summer skin, but there are other important steps that you should take to make sure that you look your best this summer. Below are my top 10 tips:

1. I usually see an increase in cosmetic procedures pre-summer for things like injectable fillers (Restylane, Juvederm, Radiesse, Sculptra) and Botox. This only makes sense because Spring/Summer beauty trends lean toward natural looks and beautiful skin. Injectable fillers are a great way to enhance certain features on your face, and even help correct dimples caused by liposuction or irregular distribution of cellulite. If done correctly by an experienced dermatologist, your results should look very natural.

2. Protect Your Lips! Always apply sunscreen or a lip balm with a minimum SPF 15 to your lips BEFORE applying your lip-gloss/lipstick. Many lip products contain castor oils and petroleum jelly. These oils coat the lip and actually increase the amount of sunlight that penetrates the skin on your lips. It is like putting baby oil on your lips. This will increase the lip wrinkles and the risk of skin cancer on your lips. Try the kaplanMD LIP 20, which moisturizes, repairs, plumps and protects with SPF 20.

3. Laser Hair Removal. A popular pre-spring/pre-summer procedure I perform in my office is laser hair removal in the underarm and bikini areas of women, and backs and necks for men. Remember, it takes anywhere from 2 to 5 treatments for the best results, so begin your treatments early.

For men, I am now lasering away facial hair on the neck. Even if a man has a beard, he does not have to spend time shaping it. By removing hair on the neck and adam’s apple area, a man has less to shave, and gets fewer ingrown hairs.

4. Reduce Ingrown Hairs in Women. To get rid of unsightly shaving bumps or ingrown hairs in the bikini area or underarm, your dermatologist can inject the area with a dilute anti-inflammatory. The inflammation of the pimple will flatten within a 1 to 2 days.

5. Botox Can Reduce Sweating. For women who love wearing tank tops but are concerned about underarm sweating, or the residue of anti-perspirants, know that Botox® has been FDA approved to treat excess underarm sweating, also called hyperhydrosis. It is very effective, and lasts approximately 6-8 months.

6. Remove Spider Veins. Again, with spring/summer beauty trends leaning toward au natural make-up and more time in the sun, consider getting laser vein removal for those pesky red spider veins around the corners of your nose. There is virtually no down time and the results are immediate.

7. Remove Varicose Veins. New lasers, as well as the standard sclerotherapy, can treat unsightly spider and varicose veins on your legs. Results are immediate and long lasting.

8. Scrub Away. How to get the beautiful after winter, summer skin glow? Exfoliate with a mild scrub 2 to 3 times a week. I recommend scrubs that contain date seed power or pineapple and papaya enzymes. These are all natural, botanical ingredients that are mild yet effective.

9. Use A Clay Mask. Increased humidity and high temperatures in the summer lead us to sweat more, and cause more oil and buildup on our face. To refine skin, remove dead skin cells, and tighten pores, I recommend using a clay mask 1 or 2 times a week. I do not recommend exfoliating and using a scrub on the same day, as this may dry out your skin.

10. Know your SPF. Some things most people don’t know about Sunscreen:

1. It should be applied 30 minutes before you go out in the sun to give the product time to penetrate your skin. If you apply sunscreen while you are outside in the sun, you are basically exposing your skin to UV radiation for the first 30 minutes.

2. For the absolute highest sun protection, use a sunscreen that contains physical sunscreens such as titanium dioxide and/or zinc oxide. These particles lay on top of your skin and actually deflect light away from your skin. The higher concentrations work better at blocking the sun, but also can leave a slight residue discoloration on the skin. This is particularly an issue for people who want to wear sunscreen on their face, but don’t like the white residue or skin discoloration. Try the kaplanMD Day Cream SPF 15, which contains a highly micronized titanium dioxide, along with 9 other active ingredients. An anti-wrinkle cream, moisturizer, and SPF 15 all in one, the kaplanMD Day Cream SPF 15 leaves no messy white residue while providing long-lasting sun protection.

3. Most people don’t apply enough sunscreen. To get the full benefit of a sunscreen, it must be applied liberally.

4. Use at least an SPF 15. Higher concentrations give only marginal improvement in sun protection, but can also irritate your skin, and leave a white residue. This residue following the use of ultra-high SPF products is particularly bothersome in Asians, African Americans, Hispanics, and anyone with a darker complexion.

5. Re-apply your sunscreen every 3 hours. There is no such thing as a water-proof sunscreen. Some are water-resistant, but you should still re-apply your sunscreen often.

6. Don’t forget to wear a hat to protect your scalp (even for women) and sunglasses to protect your eyes. And use lip products that are “all-in-one” that plump, repair, moisturize, and contain SPF.

Make Me Heal: Have you gotten any cosmetic procedures done?

Dr. Kaplan: I give myself Botox injections to my forehead, frown lines, and crow’s feet. I actually do the injections on myself, using a mirror. I also use my own kaplanMD skincare products.

About Dr. Stuart Kaplan

Dr. Stuart Kaplan graduated with honors from New York University, earning his Bachelor’s Degree in Biology with honors in two and a half years. He applied for medical school in his sophomore year of college, and graduated from the Albert Einstein College of Medicine. He completed his Dermatology residency at UCLA Medical Center, where he was chosen as the Chief Resident of the program in his final year. A nationally renowned Cosmetic Dermatologist, Dr. Kaplan’s office is in Beverly Hills, where he has been in private practice over 22 years. He has also been an Assistant Clinical Professor at UCLA Medical Center and the Wadsworth VA Medical Center for 20 years. In 2008, Dr. Kaplan was listed by the Consumer’s Research Council of America as one of America’s “Top Dermatologists.” He has received numerous awards from the American Cancer Society, the American Medical Association and the United States Congress. He has been honored for his volunteer work by the youth and foster children of Los Angeles County, Children of the Night, and Youth Organization United. He lectures and teaches other dermatologists about the newest cosmetic advances, and is a frequent medical consultant for the media including CNN, MSNBC and Entertainment Tonight, as well as the Los Angeles Times, In Style, and Glamour Magazine, to name a few. Dr. Kaplan’s philosophy is simple: help patients look as good on the outside, as they feel inside.

Visit Dr. Stuart Kaplan’s website.

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Until the last few years, most American women only cared about getting bigger breasts and tucking their tummies. But now, the new trend is to have a balance between breasts, waist, and…buttocks. With a copious butt jumping to the high priority list, buttock augmentation procedures have soared over the last few years. Another eason women have their buttocks augmented is due to excess amount of exercise. According to experts, women who work out hard tend to lose the natural curve and shape of their rears.

When it comes to a buttock augmentation, patients have two main choices. The buttocks can be augmented using implants (gluteoplasty) that are typically made of silicone or through fat grafting which means adding a patient’s own fat to her rear. Similar to inserting implants, fat grafting involves transferring a substance through small incisions. While artificial implants are falling from favor, more patients are considering the fat grafting technique to accentuate their figure and give it an added boost.

Make Me Heal turned to Dr. David Matlock and interviewed him about the popular Brazilian Butt Lift that he performs. A regular on the “Dr. 90210″ television show, Dr. Matlock is world renowned for performing vaginoplasties and laser rejuvenations, having pioneered these procedures over a decade ago (see related article on Dr. Matlock’s Vaginoplasty & Laser Vaginal Rejuvenation).

Make Me Heal: Please discuss the different types of buttock augmentation procedures that are available and which of these procedures is the most common?

Dr. Matlock: There are buttock implants and autologous fat transfer (AFT) to the buttocks. The only one I do is the AFT. This procedure is very safe and produces a natural result to inspection and feel. The incision is only 3 mm at the bottom of the buttocks in comparison to the implant which is about 3 to 4 inches in the crease of the buttocks. These artificial implants are hard and unnatural and I don’t recommend it.

Make Me Heal: Your signature is the “Brazilian Butt Lift”. Please describe how it is performed and other technical details.

Dr. Matlock: My signature is the Brazilian Butt Augmentation. The patient can have any anesthesia they want. The fat is harvested from areas of unwanted fatty deposits such as the butt, the stomach, and the thighs. It is processed and then injected into the fatty tissue of the buttocks trough micro fat injections to achieve a long lasting, uniform, smooth, and natural appearance to the buttocks. An additional benefit of the Brazilian butt lift is that you not only get a shapelier buttock, but the area to liposuction is now much leaner, giving your profile a more sensuous look.

Make Me Heal: When the fat grafting procedure is used, how is the shape of the buttock maintained?

Dr. Matlock: I first sculpture out the most aesthetically pleasing buttocks, then I aesthetically place the fat into the fatty tissue of the patient’s buttocks.

Make Me Heal: Why do you prefer using fat grafting for buttock augmentation instead of an implant? What are the advantages of fat grafting?

Dr. Matlock: I prefer and perform fat grafting as it provides a 100% natural look to feel and appearance.

Make Me Heal: Is there a specific age range for a woman seeking a buttock augmentation, or can a woman of any age have it?

Dr. Matlock: There are no age restrictions for this procedure although most patients are between their 20’s to 40’s. Patients must have enough donor fat from 2-3 areas of their body in order to be a candidate. All patients are evaluated based on the quality of their fat, existing volume, skin elasticity and buttock shape. Though some of these qualities change with age, these are really independent of their age, and a healthy person of any age can undergo this procedure.

Make Me Heal: How long do the results of a buttock augmentation via fat grafting last?

Dr. Matlock: We tell patients that what they have a 3 months will be there for life. My administrator had it 5 years ago and it is still there. I usually tell patients that 60% will last. We always overfill to compensate for what can be reabsorbed.

Make Me Heal: How is the recovery like from the various types of buttock augmentation procedures? What symptoms can a patient expect to have and for how long do they persist? Is there any period of time the patient should expect to be resting and not be active or at work?

Dr. Matlock: The artificial implant causes extreme pain. The AFT or Brazilian Butt Lift is no more painful then regular liposuction.

Following the butt augmentation procedure, you must not sit directly on your buttocks for two weeks. Most people can return to work in 2 weeks, provided you do only a minimum amount of sitting. You must wear a special garment (to control swelling) for two weeks. There may be a small amount of swelling for up to 6 weeks. However, you should be able to resume all normal activities at 4 weeks post op.

Make Me Heal: Are there any scars following a buttock augmentation via fat grafting? If yes, then can they be seen to the eye?

Dr. Matlock: The scars are only millimeters in length and usually fade to being miniscule.

Make Me Heal: What are the average costs of performing a buttock augmentation via fat grafting?

Dr. Matlock: For the total procedure it averages between $8, 000 to $10,000 depending on the amount of areas to be suctioned.

Make Me Heal: What recovery products can be used following a buttock augmentation via fat grafting?

Dr. Matlock: Arnica Montana is my favorite for its healing properties.

Make Me Heal: How long does a patient have to avoid having sexual intercourse after a buttock augmentation procedure?

Dr. Matlock: Intercourse can be resumed in 4 days.

Board Certified by the American Board of Obstetrics and Gynecology, Dr. Matlock is the founder of the Laser Vaginal Rejuvenation Institute in Los Angeles and is the Medical Director of the Laser Vaginal Rejuvenation Institute®, Inc., a training center for physicians. Author of the new book, SEX BY DESIGN, Dr. Matlock is the pioneer in this unique field of Boutique Cosmetic Gynecologic Laser Surgery. Dr. Matlock is the world renowned developer of Laser Vaginal Rejuvenation® (LVR®) and Designer Laser Vaginoplasty® (DLV®). LVR® is for the enhancement of sexual gratification and DLV® is for the aesthetic enhancement of the vulvar structures. Dr. Matlock is a featured cast member on E!’s smash hit “Dr. 90210.”

Website: http://www.drmatlock.com

Tags: celebrity, plastic, surgery

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