By Lois W. Stern, Editor-at-Large, Makemeheal.com

The world of plastic surgery seems poised for innovation once again! How about a facelift without surgery? Sounds too good to be true? Stay tuned.

By lifting the ban on federal funding for promising stem cell research, on March 9, 2009 President Obama brought this highly charged topic to the forefront once again. Not surprisingly, anti-abortion rights activists condemned Obama’s decision. Although I strongly applaud his stand, I certainly would never support the use of our finite supply of embryonic stem cells for beauty enhancement treatments – nor have I heard of any reputable surgeon who advocates such research and application for anything short of curing human disease and restoring body parts. But anti-aging specialists and plastic surgeons now have discovered other sources of stem cells - unburdened by moral and ethical decisions. Enter adult stem cells.

Understanding Stem Cells

A stem cell is a cell from which other types of cells develop. Stem cells have the ability to make more of themselves and to differentiate as they do so, in order to grow a wide variety of tissues. While embryonic stem cells are the most well-known type, not all multi-potent cells come from embryos. An abundant source of stem cells also can be harvested from our own fat. Within this past decade, researchers have begun to recognize that these pre-fat cells were actually stem cells that could be coaxed into becoming not just more fat, but cartilage, bone, and even neurons and heart muscle. Because of their diverse capablilities, these stem cells are known as multipotent.

Researchers are discovering that the lipoaspirate from liposuction, which we make in our bodies, can be converted into cells having the ability to differentiaten and replicate. By capitalizing on stem cell biology, plastic surgeons are beginning to implement methods for using those cells to reconstruct lost tissue and to build new tissue in less invasive ways than ever before.

Fat Grafting in Development

Plastic surgeons, recognizing that fat is an ideal material for soft tissue augmentation with the most natural-appearing results, have been reinjecting fat into faces for decades. The biggest problem with this procedure has been the resorption or breakdown of the reinjected fat, with resulting impermanence to the improvement.

“The grafted fat must gain its own blood supply in its new location in order to persist long-term, and this generally is not possible when large amounts are

injected at once and when specialized instrumentation and techniques are not employed,” explains board certified plastic surgeon, Dr. Michael Law.            

Structural fat grafting, also known as lipostructure or microfat grafting, has been a step forward in establishing permanence of the reinjected fat. With this process, small amounts of fat (less than 0.1 cc at a time) are carefully microinjected in a series of discrete layers to gradually build new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist.

This procedure requires specialized training and specialized surgical instruments, as well as patience on the part of both surgeon and patient, but when performed properly, permanent improvement in facial plastic contours is possible.  

Researchers are experimenting with new ways to process fat so that these fragile stem cells can create a blood supply for the transplanted cells to help them survive. One experimental method has involved separating out multipotent adult stem cells and growing them in a petri dish, while coaxing them to differentiate into specific tissue types such as fat or cartilage.  Those differentiated cells are then injected into the patient, where they continue to grow and divide, creating a small amount of natural tissue.

Photos courtesy of Dr. Vincent Makhlouf - Des Plaines

A second method uses mechanized means to accomplish similar goals. Cytori is a San Diego-based company that makes equipment to process fat stem cells immediately after the doctor liposuctions off some of the patient’s fat. Half that fat gets set aside, while the other half is processed to extract a condensed mixture rich in stem cells. That mixture is then injected back into the reserved fat, producing a fat graft supercharged with stem cells, ready to be reinjected into the patient. The result is an immediate fat graft supercharged with stem cells. An additional benefit is that because the patient is the donor, there is no risk of tissue rejection.

Photos Courtesy of Skin Essentials@bod:evolve 

The Facelift of the Future

Today many diverse procedures are being utilized to rejuvenate the face. While some involve surgery such as eyelifts and facelifts, other non-surgical options have emerged in the past ten years as a means to temporarily rejuvenate the face. Enter muscle relaxers as Botox (and more recently Reloxin), and fillers such as Juvederm, Radiesse and Restylane. These options can provide patients with a younger, more rested appearance, but because they are only temporary measures, injections need to be periodically repeated.

Photos courtesy of Dr. Vincent Makhlouf - Des Plaines

If clinical trials continue to show promise, the “Stem Cell Facelift” may just be the next huge step forward in facial rejuvenation. This Stem Cell Facelift would involve removing fat from a patient’s body – typically from the thigh or abdomen - processing it in some way and then injecting it back into that same person’s face - all in a single procedure. Anti-aging specialist and plastic surgeon, Dr. Vincent Giampapa, Assistant Clinical Professor at UMDNJ Medical Center in Newark, New Jersey and Director of The Plastic Surgery Center Internationale and the Giampapa Institute for Age Management, has pioneered this procedure and has been performing it for the last four years. He claims that the patients he has treated have exhibited not only marked improvement in both the underlying soft tissue contours of the face but also in skin quality and tone and that the results it yields are extremely natural. Priced at $5,000, it is considerably less costly than a surgical facelift that typically costs triple that amount.

Photos courtesy of Dr. Vincent Makhlouf - Des Plaines

Dr. Renato Calabria, a plastic surgeon with offices in both Italy and Ca., is slowly integrated this technique, which he calls the “Stem Cell Enhanced Facelift”, into his own practice. By introducing these reengineered stem cells into specific layers of facial tissue during the surgical facelift, he claims to see dramatic improvement in not just facial contour, but in skin quality and tone as well. He believes that the growoth factors contained in the implanted  cells stimulate skin renewal properties.

Will this change the way facelifts are done in the future or better yet, provide us with that dream come true -  a cost effective, knife-free facial rejuvenation procedure performed in an office setting requiring only local anesthesia, with shorter downtime and natural, long lasting results.

The hope for the future is that one day we will be able to say yes to all of the above and that these reengineered stem cells will be used not only to fill out wrinkles on an aging face, but also to replace lost breast tissue or augment the breast without the insertion of an implant.

Lois W. Stern, Editor-At-Large at Makemeheal.com, is a beauty expert and author of Sex, Lies and Cosmetic Surgery and Tick Tock Stop the Clock.

Lois has also just come out with an incredible DVD for plastic surgeons, which is a practical communication tool for use between surgeon and patient.  Check out Lois’s website at: www.sexliesandcosmeticsurgery.com.  Lois and Patty Kovacs are the co-founders of Coast to Coast - Eye on Beauty Newsletter.

as well as a DVD for Professional office use - a practical communication tool for use between surgeon and patient. See her website at: www.sexliesandcosmeticsurgery.com/

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By Patty Kovacs, Editor-at-Large, Makemeheal.com

Want to increase your breast size and slim down your mid-section at the same time?

After years of medical research, specialty trained plastic surgeons are successfully increasing a woman’s breast size using the patient’s own fat along with fat stem cells. This revolutionary plastic surgery procedure is opening a new frontier in breast augmentation and causing interested patients to look more closely at their options.

For years, saline and silicone implants have served as the most viable method for breast augmentation patients, but inserting saline or plastic into one’s body is considered by some women as a procedure that poses health concerns. While saline or silicone implants are ‘foreign objects’ placed into the body, innumerable studies and FDA approval declare both saline and silicone implants to be safe. Breast augmentation and liposuction were front runner plastic surgery procedures for 2008, and are proving to continue to be so in 2009.

The relatively uncommon fat grafting breast augmentation procedure has women everywhere buzzing about the benefits of this seemingly more natural breast enhancement option. So what’s a woman to do? First, decisions mean options and options are a good thing. Present clinical evidence does not conclude that fat grafting is safer or better than saline or silicone implants, but the idea of taking one’s own fat and repositioning it to augment the breasts is rapidly capturing the attention of medicine, consumers, and the media. I decided to take a more careful look into this procedure as the beauty buffet of breast augmentation procedures is likely to bring a feast of pros and cons and confusion is best converted to clarity.

Autologous fat grafting, also known as fat transfer (AFT), is a procedure in which fat cells are harvested from one part of the body and injected into another. It’s gaining acclaim rapidly. Proponents of fat grafting breast augmentation say it can be very effective in enhancing the size and appearance of the breasts using one’s own tissue. The procedure can also soften the appearance of existing implants and hide visible rippling which is particularly apparent in very thin women with a bony chest wall and little skin or fat with which to work.

The process typically increases breast size by one cup size. Recovery time is argued by opponents to be less than with traditional implants, as both the breast and donor site must heal. Also, patients need to have an adequate supply of excess fat for the procedure. Opponents claim it can take up to six months or more for breast shape results to complete post surgery as opposed to implants where recovery and results appear in six to eight weeks. But the surgeons with whom I spoke expressed short recovery following the fat transfer procedure claiming their patients could return to work in only a few days.

Methods for tissue harvest and tissue injection have been refined. Fat cells are carefully removed by a specialized liposuction procedure using numerous syringes and transferred to the breast via dozens of minutely small injections. This technique results in increased survival of the fat cells. There remains debate over how much of the transferred fat remains long-term, but the doctors with whom I spoke said it could possibly last a lifetime, unlike implants which are recommended to be replaced at least every ten years.

The procedure can be very effective in enhancing in enhancing the appearance of the breast for breast reconstruction. Fat grafting breast augmentation can also soften the appearance of existing implants, particularly in very thin women who experience visible rippling with their implants.

Augmenting the breast with the body’s own fat first became popular in the 1980s; however, both ASPS and ASAPS initially cautioned its members against the technique because of side effects such as oil cysts, calcification, and tissue scarring. The calcification in particular made it difficult for mammogram readings to distinguish between calcifications associated with breast cancer and calcifications associated with fat transfer.

A renewed clinical interest in fat grafting for both reconstructive and aesthetic purposes has emerged and surgical proponents of the procedure are calling it the wave of the future in aesthetic breast enhancement procedures.

I decided to go straight to the top and speak with Dr. Mel Bircoll, retired Board Certified Plastic Surgeon and Chief of Plastic Surgery at the former Beverly Hills Medical Center, a prestigious facility which catered to the upper crust of Beverly Hills, on the site of what is now the Peninsula Hotel. Dr. Bircoll, an icon of medicine and the first doctor to perform liposuction in North America in the latter 1970’s, now resides in Bel Air and remains active on advisory boards for fat transfer procedures and stem cell research.

“My esteemed clientele were so pleased with the progressive face lift procedures I performed in the 60’s, 70’s and 80’s, they kept asking me, ‘Dr. Bircoll, can you take it from here (thighs) and place it here (breasts)?’ To accommodate their pleas I introduced the first fat transfer procedures in the United States in 1984,” Dr. Bircoll declared.

How did he come up with the first successful fat transfer procedures in North America? Dr. Bircoll explained that fat transfer procedures were going on as early as 1890, but that the procedures did not produce tissue that could be oxygenated; thus, the fat transfer tissue would die. He figured if he could inject a small enough quantity into the center of vascularized tissue, each minutely small quantity would get its oxygen supply and survive. Breathing room meant survival of the fat cells and that meant success. His procedure is the very foundation of today’s multiple micro injections procedure for successful fat transfer. Each of the micro injections receives oxygen and the procedure, when done properly, brings outstanding results, he reports. Fat is successfully removed from the patient’s own body and placed into the patient’s breast, all using the person’s own fat, creating a naturally enhanced breast with no foreign implant.

One of Dr. Mercoll’s select students is Board Certified Dr. Todd Malan of Scottsdale, AZ, now a teacher of Dr. Bircoll’s method and Founder of the signature breast augmentation procedure, the “Natural Breast Augmentation.”

Dr. Malan explained to me, “The method for harvest and injection of the patient’s tissue is a highly refined approach. But we’ve achieved success unlike any other fat transfer breast augmentation procedures. Procedures previously performed in the 1980s provided only 50 per cent of fat cells surviving. The procedure we perform today maximizes fat stem cells to provide an 85-90 percent survival of the cell. We implement a method of harvesting the fat cells that places little to no trauma on the harvested fat and allows the aesthetic enhancement to last (potentially) a lifetime. Fat cells are carefully removed by liposuction using syringes and transferred to the breast via dozens of micro injections. The ‘Natural Breast Augmentation’ technique results in greatly increased survival of the fat cells, and though there remains debate over how much of the transferred fat remains long term, we see no reason to believe it is not for life.”

Dr. Malan has trained only six surgeons in the United States due to the precision and surgical expertise required to perform the procedure correctly. One of his elite students, Dr. August Accetta, of Huntington Beach, CA (www.accettamd.com) told me he is amazed regarding patient satisfaction and success with the procedure.

“Finally my patients who have long desired breast enhancement but did not wish to have implants due to their not wanting a foreign substance in their body nor on their breast wall, comment that the procedure has offered them a wonderful, full, all natural, utterly beautiful breast enhancement and they’re elated. It’s a tedious procedure requiring meticulous attention to every detail and should only be performed by a highly trained specialist, but the end results can be astonishingly natural and beautiful,” acclaims Dr. Accetta.

He says there are four primary reasons for patients to request Natural Breast Augmentation: First, general augmentation. Second, restoration to pre- pregnancy breast size, shape, and appearance. Natural Breast Augmentation is also performed to correct embarrassing size discrepancies, and, lastly, restoration following surgical lumpectomy procedures.

“As long as the fat is injected in the correct way, the patient will be overjoyed that her breasts look and feel 100% natural,” said Dr. Accetta. “This is the very first procedure to allow doctors to use everything nature gave us to help a woman obtain that perfect hourglass figure… naturally!”

In 2007, the highly respected medical association, American Society for Plastic Surgery (ASPS) , formed a Fat Graft Task Force to conduct an assessment regarding the safety and efficacy of autologous fat grafting (AFT). I spoke to Dr. Karol A. Gutowski, Chair for the ASPS review, about the results of the study.

“We looked at studies from around the world and concluded that while there are a lot of concerns, there’s much evidence showing positive results from this procedure. We actually couldn’t find strong evidence showing why not to perform this procedure for breast augmentation, but we also didn’t conclude this is the best technology there is for achieving certain specific goals, say for breast reconstruction. The standard now for breast augmentation is implants which has its pros and cons; same is true for fat grafting. Unfortunately, we have no formal studies comparing the two. Maybe in the near future as we could use more information and studies on this.”

While there is one registered prospective clinical trial (BRAVA, clinicaltrials.gov ID:NCT00466765) and other non-registered prospective trials involving fat grafting to the breast, no randomized controlled trials were identified during the literature search.

As the procedure continues to grow in demand, numerous surgeons are creating their own ‘signature’ or trademark procedure of the fat transfer breast augmentation. In reply to safety, proponents argue that sophisticated radiology and modern digital mammography equipment of today can better distinguish cancer cells from benign ones when examining dense breast tissue. Advocates state that fat grafting breast augmentation does not compromise accurate mammography readings any more than implants, and, in fact, most of them feel the procedure means far less mammographical compromise than implants. Opponents suggest more research is needed before concluding that the procedure’s benefits outweigh risks.

The process typically increases breast size by one cup size. Recovery time may be less than with traditional implants, as both the breast and donor site must heal. Patients need to have an adequate supply of excess fat for the procedure.

Opponents claim it can take longer for results to take shape after the procedure as opposed to implant procedures. There remains debate over how much of the transferred fat remains long term. Formal clinical trial evidence does not exist to suggest that fat grafting is safer or better than saline or silicone implants.

The American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) urge consumers to proceed carefully with any breast enhancement procedure.

As with all aesthetic surgical procedures, research the facts, I want to emphasize how important it is to consult only with a Board Certified Plastic Surgeon, compare the stratum of fat transfer breast augmentation procedures, and examine carefully all before and after procedure results.

Patty Kovacs, Editor-At-Large at Makemeheal.com, is a published author and beauty expert. Patty is the Executive Producer/Host of The Health and Beauty Revolution Show on wsRadio. Her 800+ interviews include over 450 New York Times best-selling authors. Patty

See Patty’s Websites: www.pattykovacevich.com

Patty Kovacs and Lois W. Stern are the co-founders of Coast to Coast - Eye on Beauty Newsletter. Check it out!

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Dancing with the Stars alum Lisa Rinna is as well known for her plastic surgery enhanced appearance as she is for her dance moves. But when Lisa posed for Playboy for the second time, Make Me Heal decided to explore her cosmetically enhanced changes over the past decade.

When the 45-year actress first posed for Playboy back in 1998, the biggest bulge was her pregnant belly. Now, over 10 years later, the focal point is on her out of control over-injected lips, which are the focus of every photo.

New York plastic surgeon Dr. David Shafer says, “Lisa appears to have Botox in her forehead and fillers in her cheeks and lips. She has a few pictures where it looks way too overdone.”

Even Lisa has admitted to overdoing the fillers, saying, “I saw a picture of myself and thought, ‘Uh-oh.’ You have to be careful. I’m a perfect example of that! There are many things you can do to make yourself look better.”

Lisa looks as though she’s been having more than just a lip augmentation, given her high cheeks and tight skin, and she may have had mid facelift and cheek implants or fat grafting and fillers to keep them looking high as ever. Her eyelids are also remarkably sag-free, which could be the result of a blepharoplasty.

Plastic surgeon Dr. John Di Saia says, “She is big on fillers for her lips. She has lost weight since the earlier images. Her implants are small and look nice. She probably has had some more facial work - a lift and/or mid-face lift plus or minus cheek implants.”

In addition to having a great deal of facework, Lisa also could have had breast implants placed at some point in the past, giving the high, round shape of her breasts.

Dr. Jennifer Walden, “Dancing with the Stars contestant, Lisa Rinna, has openly admitted to having had injectables to restore volume in her face. It looks as if she has either had collagen or hyaluronic acid fillers injected into multiple areas of her face, filling the nasolabial folds and plumping up the cheeks and lips. From her Playboy photo spreads it can be seen that she likely has had breast augmentation in the past.”

Rinna says the culprit of her trout pout is Juvederm, one of the more popular fillers amongst Hollywood’s leading ladies.

She says, “At my age, you have to look good if you want to continue working. Sometimes we do things to help, and I did. I had tried Botox, and then fillers came into the plastic surgery world, and you think, ‘That’s not a bad idea.”

Dr. Paul S. Nassif, a facial plastic and reconstructive surgeon and a rhinoplasty specialist in Beverly Hills, California says, “Lisa Rinna looks as though she has had an over-aggressive rhinoplasty at some point, leaving her with a pinched-looking nose. Since her original Playboy spread, her eyes look the same, as do her extremely plumped lips.”

Plastic surgeon Dr. Sherrell J. Aston says, “Lisa Rinna is yet another Hollywood actress taking plastic surgery to extremes. Lisa has admitted to being addicted to fillers, and her face shows the damage of her abuse. When she posed for Playboy 10 years ago she was a fresh starlet from the hit show Melrose Place. Sadly, her latest Playboy pictorial looks like 25 years have past. The severe lighting, bad make-up and hair are not helping the aging actress. She appears to have had breast augmentation, fillers, and possibly blepharoplasty. I would advise her to stop using dermal fillers immediately.”

Read the complete celebrity plastic surgery profile of Lisa Rinna on Plasticopedia, the largest celebrity plastic surgery encyclopedia.

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By Lois W. Stern, Editor-at-Large, Makemeheal.com

With the many innovations of modern day plastic surgery, none seems to be gaining in popularity more rapidly than a variety of emerging technologies for the removal of unwanted body fat. Although diet and exercise remain the first line of defense against weight gain, when it comes to eliminating stubborn pockets of fat, these strategies often have fallen short of expectations. Enter modern day fat removal technologies.

With increasing interest in issues of health and beauty, it is little wonder that a number of plastic surgery technologies have stepped up to the plate to meet popular demand, while addressing America’s fixation with the battle of the bulge. According to statistics gathered by the ASAPS (American Society for Aesthetic Plastic Surgery), last year lipoplasty (liposuction) ranked second in frequency of all surgical procedures performed in the United States with a total of 309,692 lipoplasty procedures. Within this number, 90% were performed on women, a figure consistent with the overall gender ranking for all surgical procedures.

Although tumescent liposuction is still an effective procedure for the removal of large fat deposits, one of the disadvantages of this procedure is its tendency to leave behind unattractive, loose skin. This is where Smartlipo, an innovative laser-assisted device, enters the playing field. It is also one of the reasons it is rapidly becoming the gold standard for the removal of unwanted body fat. In some cases, Smartlipo, also known as lipolysis, is being used as a viable substitute for tumescent liposuction. In other cases, where larger amounts of body fat are involved, Smartlipo is being effectively employed as a complement to traditional liposuction by helping surgeons tighten the loose skin left behind from a tumescent liposuction procedure.

Typically, areas treated effectively through Smart Lipo technology include the chin and neck areas, inner and outer thighs, knees, abdomen, upper arms, hips, “bra fat”, “love handles“, and male breasts.

Before/After Photos Courtesy of Dr. Barry DiBarnardo

How Smartlipo Works

Board certified plastic surgeon, Dr. Alan Kisner, explains how Smart Lipo works:

“Normally the patient is injected with a local anesthesia before the lipolysis procedure. Treatment begins when the surgeon inserts a micro-cannula (tiny tube) about the size of a thick syringe needle into the skin. The tiny incision made for the entrance of the cannula is so small that no stitches are required after the procedure.“

“A three hundred to six hundred micron optical fiber is placed within this micro-

cannula, which is approximately 1.0 mm to 2.0 mm in diameter. This optical fiber extends two mm beyond the cannula. Because the aiming beam is very bright, it is visible through the skin, enabling the surgeon to see exactly where he is working. The laser causes small blood vessels to coagulate immediately, keeping bleeding, swelling and bruising normally associated with traditional fat removal techniques to a minimum.“

“As the surgeon moves this cannula in a slow, fan-like motion through various depths of fat tissue, the optic fiber delivers laser energy in short pulses, which heat the targeted fat cells in the top layers of the patient’s skin. These fat cells rupture and liquefy. The resultant oily liquid substance is then removed with another micro-cannula.“

Of particular significance with any fat melting technique lies a concern for what happens to that fat as it is melted within the body. With Smartlipo, research has shown that little if any fat is reabsorbed into the body.

Further benefits of Smartlipo include both its potential for stimulating the formation of new collagen and for its reduction of cellulite.

During treatment, controlled wounding results in stimulation of new cells under the patient’s skin, which is thought to produce new collagen. Furthermore, the thermal energy within the dermis causes shrinkage of the fat cells residing between the collagen fibers (the bands that keep our skin tight and in place). When fat cells are removed from between these bands, it may result in reduction of cellulite.

Before/After Photos Courtesy of Dr. Jeff Schafer

Before/After Photos Courtesy of Dr. Bruce Katz

Recovery After Smartlipo

The recovery period after a Smartlipo procedure is brief and relatively painless. Patients are typically sent home within one hour after the completion of the procedure with compression bandages to prevent affected tissues from shifting. In some cases, surgeons recommend that the patient wear a compression garment for a short period of time during recovery. Minor bruising and numbness occur after the procedure, but disappear within days after leaving the recovery room. Swelling is normally observable for the first week and gradually tapers off thereafter. Normally one is able to return to work within two to three days and is able to resume exercise and full activities after two weeks. Results become visible within one week, with continued improvement noted over a three to six month period.

Improvements in Smartlipo Technology

The first Smartlipo design was pioneered in Europe and South America beginning in the year 2000. In November, 2006, it became the first laser assisted liposuction technology approved by the FDA. Made by Cynosure, the original Smartlipo machine has already undergone improvement to increase its effectiveness. The newer model, the Smartlipo MPX, employs 2 lasers: the 1064 to treat the deeper fat and 1032 laser to tighten the skin. This model also incorporates some practical innovations in response to plastic surgeon input. Early models worked effectively but slowly, causing considerable surgeon fatigue. As surgeons expressed a need for a model that would work more rapidly, Cynosure searched for a solution, which they amusingly reached while observing the Wii Video Game system in action. Noting how the Wii chip responded to the speed and motion of the user’s arm while swinging a tennis racket or tossing a bowling ball, Cynosure was inspired to develop and insert a similar chip into their latest Smartlipo design, to respond to the speed and motion of the surgeon’s arm during the lipolysis procedure.

Smartlipo Costs

Smartlipo costs will vary depending upon the surgeon performing the procedure, the surgeon’s experience and location as well as the size of the areas to be treated. Although costs for Smartlipo tend to be a slightly higher than those of other modern liposuction techniques, other factors likely to reduce the overall cost need to be considered, including lower anesthesia and recovery charges. Another factor worth considering is the shortened recovery time following Smartlipo due to minimal tissue trauma, which spells less time lost from work.

Look for Dr. Kisner’s chapter, When Diet and Exercise Aren’t Enough, with his amazing before/after photographs in my about-to-be-published book, Tick Tock, Stop the Clock – Getting Pretty on Your Lunch Hour.

Lois W. Stern, Editor-At-Large at Makemeheal.com, is a beauty expert and author of Sex, Lies and Cosmetic Surgery and Tick Tock Stop the Clock. Lois and Patty Kovacs are the co-founders of Coast to Coast - Eye on Beauty Newsletter.

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By Patty Kovacs, Editor-at-Large, Makemeheal.com

As the number of plastic surgery procedures in the United States decline with the tightening economy, a new secret weapon in the war on wrinkles may soon become the hottest age-defying injectable treatment. Called Reloxin, this new injectable may just be the affordable version of Botox to help bailout people who cannot afford the original. Can Reloxin be as effective as Botox? Possibly. Will it be cheaper than Botox? Likely.

Presently awaiting U.S. Food and Drug Administration (FDA) approval, Reloxin is suggested by many as the up-and-coming rival to Botox Cosmetic to become the newest wrinkle fighting injectable to work magic on lines and furrows of the face, particularly the forehead area.

Like Botox, Reloxin (Clostridium botulinum toxin type A-hemagglutinin complex) is an injectable form of botulinum toxin Type A. Also like Botox, small doses of the Reloxin are injected into targeted wrinkle-causing muscles, preventing the muscle from contracting and effectively reducing appearance of wrinkles. But with Reloxin, there is a greater diffusion of the toxin from pontiff injection, quite desirable in certain areas like the forehead.

Reloxin is now approved in 23 countries outside the United States to smooth wrinkles and has also been used outside the United States for more than 15 years to under the trade name Dysport to treat neurological disorders.

Reloxin is currently sold outside the U.S. by Ipsen SA, based in Boulogne-Billancourt, France, outside Paris. In 2006, Ipsen granted Medicis the rights to develop, distribute and commercialize Reloxin as a wrinkle treatment in the U.S., Canada and Japan. Medicis is also the company behind the popular hyaluronic acid injectable Restylane.

“Reloxin is as safe and it works as well as Botox,” says Dr. Ronald Moy from the Moy-Fincher Medical Group for cosmetic and skin surgery in Los Angeles and esteemed professor at University of California, Los Angeles medical school. Having served as lead researcher in a Reloxin study funded by Medicis, Dr. Moy was impressed with the results of the objective study.

Dr. Moy spoke with Makemeheal.com recently as he shared that he’s quite in favor of Reloxin’s potential to serve the cosmetic injectables market. “Many of our patients were happier and got a more natural look with the use of Reloxin. I think it will be a serious competitor to Botox,” Moy added.

A team from the Moy-Fincher Medical Group researchers in Los Angeles conducted the study treating 1,200 patients with injections of Reloxin in sites of the forehead area of the face. As many as five treatments were given during the study. Patients were asked to record the effects of the treatment in diaries and were interviewed 7-10 days after treatment. In addition, patients were reexamined two weeks, then 30 days later, and then again each month after treatment. Many patients reported that the drug started working within days after treatment. After a week, up to 95 percent said they had responded to the medication. The study also found that in many cases Reloxin lasted remarkably long term.

Among the 1,052 patients who completed the 13-month study there were 2,838 adverse events among 880 patients. Of these, 28 percent were probably related to the treatment. These included problems at the injection site, nervous system disorders such as headache and eye problems including ptosis, a drooping of the eyelid or brow. Only one patient withdrew from study due to the side effects of the drug, the researchers say.

Another possible benefit of this new wrinkle relaxer is cost. Reloxin may turn out to be more cost effective than Botox Cosmetic. Medicis has made no decisions on pricing but sources say Reloxin may possibly be priced as much as 15% lower than Botox which will allow it to take a significant share of the billion dollar wrinkle relaxer market. At a recent conference of the American Academy of Dermatology, Reloxin had almost all participants abuzz with anticipation and excitement. Word in plastic surgery circles is that it will at the very least drive down the cost of Botox because of the competition. I’m one for a little ‘healthy’ competition in this market.

For years, Allergan has monopolized the cosmetic and therapeutic market of botulinum toxin type A, taking full advantage of their 83% worldwide monopoly by raising the price of Botox almost biannually. Botox sales for 2009 are expected to be between $1.15 billion and $1.19 billion. Last year’s revenue was $1.3 billion, about half from cosmetic sales. Botox has long been such a U.S. mainstay of cosmetic medicine to reduce forehead wrinkles and frown lines that consumers’ conversational use of the word “Botox” is both a noun and a verb by regular ‘Botox-ers’.

The arrival of a less costly injectable such as Reloxin during the worse recession in decades is timely, as some price-conscious Botoxers will likely shift to using Reloxin if the results are comparable.

Approval for Reloxin is still hush-hush, but its corporate sponsors, Medicis Pharmaceutical of Scottsdale, Ariz., and Ipsen of Paris, have refiled their application for Food and Drug Administration approval to market this new wrinkle-fighting injectable drug in the United States.

Since less quantity is required of Reloxin, the conversion rate of units will initially be sort of like learning a new language. Don’t look to convert units to units, rather work with a trusted physician to learn the required units of Reloxin for your body.

Remember, always carefully research and check the medical credentials and Board Certification of any physician or surgeon you select for cosmetic aesthetic enhancement.

Patty Kovacs, Editor-At-Large at Makemeheal.com, is a published author and beauty expert. Patty is the Executive Producer/Host of The Health and Beauty Revolution Show on wsRadio. Her 800+ interviews include over 450 New York Times best-selling authors.

See Patty’s Websites: www.pattykovacevich.com

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By Patty Kovacs, Editor-at-Large, Makemeheal.com

Back in the 1980’s Sam Muslin, DDS, MAGD, a practicing Santa Monica dentist, was testing a then unknown product called veneers to enhance the smile of a select group of his patients. What is today known as cosmetic dentistry began with pioneering expert dentist like Dr. Muslin.

Dr. Muslin’s continued application of veneers and his meticulous assessment and rebuilding of teeth to achieve a more aesthetically pleasing smile led him to perfect his art of beautiful dentistry. Developing his own signature style, he began to notice that specific applications produced distinguished, improved facial dimension. His dental work was transforming receding chins, sunken jaws, and thinning lips into stronger chins, sculpted jaws, and fuller lips. With his unique methods and dental expertise, he was creating gorgeous smiles and turning back the clock on otherwise sagging, aging faces.

He called the procedure Face Lift Dentistry as word got out and patient after patient came to him from around the country for state-of-the-art cosmetic dentistry and facial rejuvenation without plastic surgery.

Face Lift Dentistry is a unique, patient-centered, restorative, and bite-reconstructive treatment that requires only dental restorations, no actual facial surgery, yet utterly remarkable facial rejuvenation is naturally achieved. No stitches, no cosmetic injectables, and minimal to zero grinding down of the patient’s natural teeth. The procedure can be completed in as little as two office visits. Face Lift Dentistry is a level of care that exceeds all previous levels, the highest, most complex level of dental care made possible by improvements in advanced technology using Dr. Muslin’s refined techniques. This super specialty procedure is highly concentrated, utilizing and coordinating the most advanced dental technologies available to achieve the ultimate level of individualized dental care while also achieving astonishing facial rejuvenation.

“What are my goals of Face Lift Dentistry?” asks Dr. Muslin. “To achieve the absolute best jaw position and comfort, tooth angle, dental health level, clear speech, ideal facial support and optimal facial length possible. The result? A weak chin appears stronger, a short, round face is elongated, a collapsed bite is restored, and a remarkably improved facial profile results. That’s why I call it Face Lift Dentistry.”

I met Dr. Sam Muslin at a medical luncheon at the Regent Beverly Hills, sure that I would discern his technique to be somewhat questionable. He quickly proved me wrong and now I’m a fan. His results are astonishing. Facial wrinkles and weaknesses become more obvious with age. When you think about it, it just makes good sense to incorporate enhancing one’s smile and facial dimensions simultaneously. Big plus? No surgery. Dr. Muslin is going far beyond conventional dentistry and his before-and-after patient photos and testimonials tell the story.

“The Dental Face Lift technique plumps the appearance of thinning lips, adds volume to sunken cheeks, elongates an otherwise weak jaw and chin, and makes taut that ugly, loose turkey neck. The technique naturally enhances the patient’s unique soft facial tissue with restructure of the hard tissue: the teeth. In other words, it’s much more than a ‘dental smile makeover,’” he explains.

A careful, three-dimensional analysis of the patient’s entire face geometry begins the initial procedure. A highly customized course is determined to reconstruct the patient’s bite as well as to enhance the patient’s entire facial structure. No surgery is required on the face or any soft tissues. Only the teeth are treated.

“The development Face Lift Dentistry actually allows a patient to change what nature created and turn back the hands of time. Instead of being satisfied with the length of our face and the position of our jaw that we grew into randomly at a young age, we can now utilize this dental technology to achieve the best possible face, lips and jaw position possible while restoring youthfulness to the entire face,” says Dr. Muslin.

The procedure restructures the face, the bite, even the health of the entire body by maximizing the potential of the teeth to support the overall facial structure, lips and cheeks. It removes years off the facial appearance, vertically lengthening the face, actually smoothing out wrinkles, giving a naturally thicker appearance to the lips. Not only is the smile vastly improved, but the entire face is transformed to a far more aesthetically pleasing and youthful appearance by reconstruction the teeth. The teeth are lengthened to achieve a longer face and this lengthening process is harmonized with the specific requirements of the patient’s jaw-joint or TMJ. According to Dr. Muslin, in most instances the jaw-joint will move itself to the best position naturally if given the opportunity during the course of dental care.

“Wearing down of the teeth because of bruxism (grinding) is a normal process of aging. The gradual loss of vertical dimension in a patient’s face is an added result of getting older; in other words, our faces get shorter as we age because of tooth wear,” explains Dr. Muslin. “Over time, the bite is flattened and depressed facial structure follows. A face looks older due greatly to loss of tooth support and flattening of the bite. Mine is the only procedure that actually lengthens the face permanently and creates a lasting, vertically enhanced, youthful looking face.”

Dr. Muslin’s patients aren’t just aging baby boomers. A 30-year-old patient can actually have a 50-year-old looking face due to a deep over-bite and years of grinding. Short, dark yellow teeth from smoking, partying, poor eating habits, or childhood antibiotics combined with old fillings and crowns that don’t match can make a thirty-something look, well, old.

“Some of us never had a good bite to begin with. Our bite is formed in early adolescence once all of the adult teeth erupt. It’s our teeth that determine facial length and jaw position for the rest of our lives. Our faces can be short and round if the teeth don’t provide adequate support. Many of my patients experience enormous relief from migraine headaches due to teeth misalignment and grinding” continues Dr. Muslin.

As soon as mismatched crowns and fillings are replaced, the patient is made healthier. Decay is removed for maximum health and the bite is rebuilt. Conflicting metals and decaying tooth structures are replaced with biologically compatible porcelain materials.

Worn down cusps are rebuilt and restored for better chewing, adding subtle, three-dimensional vertical facial height, creating astonishing youthful restoration of the patient’s entire facial appearance. No surgery, no stitches, and most patients go back to work the very next day.

Dr. Muslin’s years of knowledge and expertise are critical in in Face Lift Dentistry. His advanced training and artistic ability are vital components for the biological harmony of this highly advanced procedure.

Dr. Sam Muslin is a Master of the Academy of General Dentistry and has been awarded by the International College of Dentists. He has been practicing cosmetic dentistry in Santa Monica for almost 30 years. Dental Face Lift and Face Lift Dentistry are registered trademarks of Dr. Sam Muslin. www.faceliftdentistry.com.

Patty Kovacs, Editor-At-Large at Makemeheal.com, is a published author and beauty expert. Patty is the Executive Producer/Host of The Health and Beauty Revolution Show on wsRadio. Her 800+ interviews include over 450 New York Times best-selling authors.

See Patty’s Websites: www.pattykovacevich.com

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February 6, 2009 - Los Angeles, CA

Make Me Heal (www.makemeheal.com), the world’s largest website for all things plastic surgery, cosmetic treatments, and anti-aging, has announced that over fifty top plastic surgeons have joined Makemeheal.com to answer questions live that are posted by consumers on the website’s Ask-An-Expert area. Launched in November of 2008, Ask-an-Expert is a free service that allows consumers to ask a question and get key answers from top doctors and experts about any procedure or topic within the fields of plastic surgery, dermatology, and skin care. Moreover, regular people from the Makemeheal.com community can also post responses to questions.

“Ask-an-Expert is rapidly becoming one of Makemeheal.com’s most popular areas of our portal, as it allows consumers to ask important questions and get answers from different leading doctors and experts at a click of a button — and for free,” says Ariel Perets, Founder & CEO of Makemeheal.com.

Aside from asking questions, users can simply use this incredible resource to do research numerous types of procedures, treatments, and products using sophisticated search functions on Ask-an-Expert.

Among the physicians answering questions on the Makemeheal.com site include Dr. Marcel Daniels, Dr. Brent Moelleken, Dr. Shervin Naderi, Dr. Alexander Rivkin, and other top plastic surgeons.

Check out Ask-An-Expert.

About Make Me Heal

Make Me Heal (www.makemeheal.com) is the world’s largest website for all things plastic surgery, beauty enhancement, and anti-aging.  With 1 million members and over 300,000 unique visitors per month, Make Me Heal is a one-stop portal for all the products, services, and information resources needed by the consumer.

Discover The Make Me Heal World…

• Find a great plastic surgeon on Makemeheal.com’s Plastic Surgeons Directory, check credentials, and read patient reviews of doctors.

• Chat, ask questions, and get advice from people on our Message Boards & Blogs.

• View or upload Before & After Plastic Surgery Pictures in the world’s largest photo library of women and men who’ve had plastic surgery.

• Ask top plastic surgeons questions & get answers live on Make Me Heal’s Ask-An-Expert area.
• Shop for Plastic Surgery Recovery & Preparation Products and Beauty & Skin Care Products.
  
• Read Plastic Surgery News & Gossip.

Visit the website: Make Me Heal

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By Alexander Rivkin, M.D.

Traditional cosmetic procedures such as rhinoplasty, blepharoplasty, facelifts, and chin augmentations are no longer the only option for individuals who wish to enhance their outward appearance. These surgical procedures are now in competition with the latest innovations in injectable filler techniques. Products such as Radiesse, Artefill, Juvederm, and Sculptra allow a skilled physician to gently mold and sculpt the face. Facial fat disappears as we age, changing our appearance from full and youthful to gaunt and fatigued looking. Fillers will replace that fat, giving us back the youthful fullness that is lost over time. In addition, fillers can easily soften and camouflage aesthetic irregularities of the face, such as a nasal bump or an asymmetric chin. With so many new choices in aesthetic medicine available, why endure painful, invasive surgery that requires anesthesia and an overnight hospital stay? In this article I would like to specifically focus on Non-Surgical Rhinoplasty, also known as the Non-Surgical Nose Job, and discuss some of the procedure’s advantages relative to surgical rhinoplasty techniques.

As a surgically trained otolaryngologist/facial plastic surgeon I understand my patients fears and anxieties associated with “going under the knife.” I have devoted my career to developing cosmetic surgery alternatives in order to reduce recovery time, discomfort, and financial cost to patients seeking cosmetic improvements. Recent developments in aesthetic medicine have allowed me to focus on minimally invasive facial sculpting as new varieties of injectable fillers are becoming more readily available in the US market. Four years ago, I was the first in the United States to offer Non-Surgical Rhinoplasty using injections of Radiesse to raise the bridge of the nose and camouflage bumps. Since then, I have performed about 1000 successful procedures and have trained physicians across the country and abroad.

The idea of correcting nasal abnormalities with the use of injections is actually not new. In the mid 1800’s doctors attempted to perform this procedure with substances like paraffin, silicone, and goose grease. These techniques did not last because the substances used caused long-term side effects and turned out to be inappropriate for injection. However, the idea of performing rhinoplasty with injections remained a possibility and modern cosmetic surgeons continued to experiment with the idea of minimally invasive facial sculpting.

When I started using Radiesse to fill in lines and wrinkles, I was impressed with the longevity and smoothness of the results. I had heard rumors that Asian plastic surgeons were using fillers to contour the nose non-surgically and I recognized the possibility that American patients could obtain results similar to traditional rhinoplasty without surgery. I questioned why US surgeons were only offering fillers as a post-rhinoplasty corrective procedure. There was (and still is for the most part) a perception that an operation is the only way to correct cosmetic nasal irregularities, even the most minor bumps or asymmetries. After using injectable fillers as an alternative to rhinoplasty for four years, I am convinced that the Non-Surgical Nose Job is a procedure that is safe and effective with significantly less discomfort and risk than traditional rhinoplasty.

With proper administration from a trained specialist, Non-Surgical Rhinoplasty can effectively correct a mild to moderate bump on the bridge of the nose, a mild to moderate drooping of the nasal tip (nasal tip ptosis), mild to moderate post-rhinoplasty asymmetry, and mild to moderate deformities such as “boxer’s nose” or an upward scooping of the nasal tip (also known as saddle nose deformity). Skill and experience are required if a physician wishes to correct more difficult situations such as asymmetric nostril shape, or poor definition at the point between the face and nostril wing.

(Left: Before, Right: After)

Cosmetic concerns often vary between ethnic groups and the Non-Surgical Rhinoplasty procedure can present the best solution across cultural lines. For example, Asians often desire a heightened bridge of the nose and want better nasal definition. African Americans, like Asians, often request bridge augmentation while Hispanic Americans frequently ask for correction of a droopy nasal tip or irregular bump. Caucasians most commonly request camouflage for an obvious hump or unbalanced appearance of the nasal bridge.

(Left: Before, Right: After)

Individuals who have already received a traditional rhinoplasty procedure commonly ask for minor corrections of asymmetry, augmentation for an upward slope of the nose, and, occasionally, a desire for augmentation and camouflage in the of the nose bridge due to a post procedure cartilage collapse.

There are several injectable fillers available on the US market today that are safe, effective and relatively long lasting. I have mostly used Radiesse and am very comfortable with this filler. Radiesse is composed of calcium hydroxyapatite microspheres in a polysaccharide gel carrier. Since there is no way to dissolve the material, it must be injected with great care. I routinely under-correct because over correction is quite difficult to resolve. Immediately after injection, Radiesse is malleable and I will contour and shape it according to the needs of the individual patient. Generally I see patients one to two weeks after the initial procedure so that I can administer touch ups if necessary. Radiesse is a semi-permanent filler and generally lasts between 10 and 12 months. Because Radiesse is not animal based, no allergy testing is required.

Some patients choose to start with more temporary hyaluronic acid fillers such as Restalyne or Juvederm in order to experiment with the outcome of their cosmetic makeover. The advantage to the hyaluronic acids is that they can be easily reversed with an enzyme in the rare event that results are dissatisfactory. After trying out their new look with temporary fillers, patients can then choose to go with a permanent filler if they decide a re-contoured nose suits their expectations (which is the case with most people). Restalyne and Juvederm last between six to nine months and are non-animal based so skin testing is not necessary and allergic reactions are unheard of.

Although the Non -Surgical alternative to rhinoplasty is an excellent option for many, it is not the best solution for all patients. Patients with a severely crooked nose may not be good candidates for an injection rhinoplasty because the augmentation needed to give a straighter appearance to the nose may make the nose too wide. Patients with a nose that is disproportionately large may need to opt for a traditional reduction surgery. The procedure will not correct breathing problems.

As with any medical procedure, selecting the right physician to perform your Non-Surgical Rhinoplasty is critical. Injecting filler into the nose must be done with care and a thorough understanding of both nasal anatomy and the properties of the filler being used. A patient contemplating this procedure should make sure his or her physician has had specific training and experience in cosmetic injection techniques, especially if the doctor is not a formally trained aesthetic surgeon. Precise knowledge about the injection spots, depth, and amount of filler needed is very important for the success of the procedure.

Non-Surgical Rhinoplasty is a relatively painless procedure that requires minimal downtime and post-procedure care. In fact many of my patients have resumed normal activities immediately after their Non-Surgical Nose Job, returning to work or a busy social calendar on the same day as the appointment. Slight bruising or swelling may occur at the site of injection, however the severity of the inflammation pales in comparison to the aftermath of traditional rhinoplasty. If discoloration or tenderness does occur, it usually disappears within a few days.

Topical anesthesia is adequate for pain control and icing the nasal area just before injection reduces the chances of bruising. I suggest patients take Arnica Montana orally after their injection – it works well for reducing any swelling or bruising that may follow. Patients can use Tylenol, but should not use non-steroidal anti inflammatory medications (Advil, Alleve, etc) for 3 days or wear sunglasses for 2 weeks after the procedure. No other limitations are required. The Non-Surgical Nose Job usually takes between 10-15 minutes to perform. Patients are usually in the office for about an hour, however, when we figure in the time needed for topical numbing cream.

Non-Surgical Rhinoplasty costs a fraction of the price of the surgical procedure. Depending the on the filler being used - temporary, semi-permanent, or permanent - a Non-Surgical Nose Job costs between $1,000 - $2,000.

Minimally invasive procedures like Non-Surgical Rhinoplasty are quickly gaining popularity because they offer patients exactly what they want cosmetically, but with much less pain, downtime, and cost. The Non-Surgical Nose Job is currently performed throughout much of the world and will only increase in popularity as the possibility of non-surgical aesthetic corrections continue to be publicized.

About the Author

Alexander Rivkin M.D. is a Yale trained facial cosmetic surgeon and UCLA faculty member who focuses exclusively on providing his patients with the latest in non-invasive, non-ablative cosmetic treatments. As an international authority on non-surgical cosmetic treatments, he divides his time between patient care, clinical research, educating other physicians, media appearances, and lecturing at scientific conferences throughout the world. Dr. Rivkin was the first physician in the country to offer the Non-Surgical Nose Job, his signature method for non-invasive correction of cosmetic nasal irregularities. He has been featured throughout the national and international media on shows such as the TODAY show, the Tyra Banks Show and EXTRA for the innovative procedures he has invented. Dr. Rivkin is a member of the teaching faculty of the American Academy of Facial Plastic Surgery. He is also a prominent member of the national teaching faculties for Allergan, Contura, Johnson and Johnson, Medicis and Bioform. Click here to learn more about Dr. Alexander Rivkin.

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By Anthony Youn, MD

As a cosmetic plastic surgeon, I often have patients ask me what’s the latest on the horizon in the field of plastic surgery. Are there procedures that they should save for? In the near future will there be cheaper and easier ways to change their look than what we are currently doing now?

Here are my Top 9 Plastic Surgery Predictions for 2009:

#9. Plastic Surgery Vacations will become more and more popular. As our country falls into recession, greater and greater numbers of people will save money by combining plastic surgery and vacations. Americans will travel to Mexico, Brazil, and even India in an attempt to save money and look better. I predict that this trend will unfortunately bring about an unprecedented number of disturbing complications, as people bring their botched results back to the U.S. for American plastic surgeons to treat. The lucky ones, however, will come back looking both rested AND younger.

#8. Fat, from both from animals and people, will become a new Green resource. There are reports that a renegade Beverly Hills radiologist used liposuction fat to power his SUV to work each day. While this is an extreme example, I do believe that the work on Biofuels will continue, with liposuction fat on the periphery of this trend. No, I don’t plan on ever doing this.

#7. Sculptra will gain FDA approval as a liquid facelift for the general population. With the realization that facial volume loss is an integral component of the aging process, Sculptra treatments may take center stage in the fight against facial gauntness. Sculptra is currently only FDA-approved for treatment of HIV-associated facial wasting, but has been used in Europe for many years under the name Newfill. It is currently the only injectable filler that can produce generalized volume replacement in the face without excessive cost.

#6. 2009 will bring with it a plethora of new extreme, bizarre, and unusual plastic surgeries. 2008 brought us such plastic surgery oddities as cosmetic leg lengthening, the G Shot, the Boob Jab, and the Acupuncture Facelift. I expect fringe medical practitioners to do the same in 2009. Can we expect to see actual rib removal to thin the body, removal of the omentum (fat around the intestines) to decrease a protuberant tummy, or tummy tucks performed at the time of C-sections? Not by me!

#5. Will Gummy Bear Implants Boost Busts in 2009? In November 2006 the FDA lifted the ban on silicone gel implants. Since then plastic surgeons and patients in the know have been waiting for FDA approval of the form-stable, “gummy bear” breast implants, the only silicone breast implants that did not receive approval two years ago. These firm, textured, tear-drop shaped implants are made to retain their shape and not conform to the shape of surrounding tissues. They are already in widespread use throughout many other countries in the world. Will the FDA approve these implants for general cosmetic use in 2009? Thousands of plastic surgeons and patients hope so.

#4: Nonsurgical Liposuction Techniques Run Rampant… As Do Disappointing Results. One of the hottest procedures today is nonsurgical liposuction. Cosmetic practices throughout the country are advertising fat reduction via injections, external lasers, external ultrasound, and even by freezing the fat (called cryolipolysis). While these techniques sound intriguing, none have actually been proven to safely work…yet. The American Society of Plastic Surgeons (ASPS) is currently conducting an FDA-approved study on Lipodissolve, with the initial results due in the near future. While the only proven way to safely and effectively remove fat is via liposuction, 2009 may bring considerable advances to some of these, so far, unproven modalities. I expect that most will fall by the wayside, although a few may be proven to safely work.

#3: Eyelash Enhancing Medication “Latisse” Hits Big in a Blink. Recently an FDA advisory panel recommended approval for this eyelash stimulating medication from Allergan, the makers of Botox. Peak sales are estimated to reach $500 million, as this treatment will be a one of a kind. I expect Allergan will see huge profits from this topical medication, as will the physicians that dispense it. And people will walk around with Tammy Faye Baker eyes…

#2: Stem Cells are the Future in the U.S., but the Present in Other Countries. Stem cells are currently all the rage in potentially curing cancers, developmental abnormalities, and other medical problems… but are they the future for plastic surgery as well? Actually, stem cells are currently being used by some pioneering (and possibly reckless) surgeons outside the U.S. Dr. Vincent Giampapa introduced a stem cell facelift in France back in October and a handful of surgeons are performing breast enhancement with stem cells in Japan and Europe. So will we see stem cells being used by plastic surgeons in the U.S. in 2009? Not likely. The FDA is cautious with allowing procedures like these to be performed here in the States, and with good reason. Scientists need to prove that the use of stem cells for indications like these is safe and effective before allowing patients to undergo it. Until then, Americans will need to travel abroad for these extremely controversial treatments.

#1: Botox-Competitor Reloxin will act as an Economic Bailout for Millions of Botox Users in 2009. FDA approval for Medicis’s cosmetic botulinum toxin Reloxin is expected sometime in the new year. This may prove to be a relief to patients and plastic surgeons who have been forced to buy Botox at increasing prices each year. I currently charge my patients $650 for Botox injections to three areas, and the price of the Botox product itself accounts for at least half of that charge. Reloxin will be the first legitimate Botox competitor to challenge Allergan’s monopoly on this market, and hopefully bring prices down for the most popular cosmetic treatment in the U.S. It can end up being an economic bailout for the millions of people who undergo cosmetic botulinum toxin treatments several times a year.

About the Author

Dr. Anthony Youn is a Michigan-based board-certified plastic surgeon, and a member of the American Society of Plastic Surgeons. He has been featured on E! Television’s Dr. 90210 and Celebrity Plastic Surgery, The Montel Williams Show, Fox News Channel, The O’Reilly Factor and quoted in US Weekly, In Touch, Life & Style Weekly, RADAR magazine, MSNBC, OK! Weekly, and Star Magazine discussing a wide range of plastic surgery issues. His blog Celebrity Cosmetic Surgery is the most read blog by a plastic surgeon in the country and has received nearly 6 million hits. Learn more about Dr. Anthony Youn.

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Does anyone know a woman who wouldn’t want to trade shaving and waxing regularly for a few painless treatments that will leave her hairless with silky skin? Because the answer for most women is a resounding no, the hottest present for this holiday season may just be a home laser hair removal device that keeps you hairless in unwanted areas for the long-term. Until now, laser hair removal has been a luxury treatment offered by doctors, aestheticians, and spas for anywhere from $400 to $900 per treatment area and on average for $3000 per year if you were treating legs, bikini line, and underarms. Now, the same laser technology is finally available to use at home safely and the FDA has approved two home-use laser devices that deliver professional-level hair removal results in the privacy of your own home with minimal discomfort.

The two FDA-cleared devices have just been launched and are Silk’n Hair Removal Device ($800) and the TRIA ($995). Besides the convenience of being able to forego the endless waxing and shaving routine and the cost savings relative to standard hair removal methods (see comparison table below), these devices have actually been proven to deliver excellent results in clinical studies.

(Left: Before Silk’n treatments, Right: 3.5 months after Silk’n treatments)

With Silk’n, women who participated in clinical trials achieved an average hair reduction of 50% following three months of bi-monthly treatment sessions. Using these devices is a relatively painless ritual, with most people reporting a slight sensation of heat, itch, or minor sting that goes away immediately after treatment. That may just be a small price to pay compared to painful waxing, continuous shaving routines, side effects like razor bumps and ingrown hairs, and expensive in-office treatments. The FDA cleared these devices for home-use, which means that when used as directed Silk’n or TRIA have been tested to have no side effects or risks. However, just like with professional spa hair removal devices, these home-devices should not be used on deep brown and black skin tones and they are not effective on blond, red, gray, or white body hair. The user satisfaction rate speaks for itself, as nearly 90% of women said they would recommend Silk’n to a friend or family member, and close to 90% described Silk’n as convenient, easy, useful and innovative.

For optimal results, the manufacturers of the devices recommend spacing treatments every two weeks during the first few months and then gradually reducing the number of treatments and using the devices again only when hair re-appears. The results are not immediate due to the nature of hair growing in cycles. During any cycle, some hair follicles will be dormant and will not be visible and then grow and become visible during the growth phase. Laser hair removal is only effective when the hair is in the growth cycle, which is why the treatments need to be repeated for some time.

The technology underlying Silk’n and TRIA is the very same technology behind professional machines found in spas and aesthetician offices. Light-based hair removal is based on the theory of selective photothermolysis in which optical energy is used to disable hair growth. To achieve this effect, the hair shaft needs to selectively absorb light energy and transform it into heat. This selectivity is achieved when high optical energy that is delivered to the tissue is mostly absorbed by hair shaft pigment, while the epidermis and the surrounding tissue is actively cooled (by a cooling mechanism). Melanin is the pigment in the hair shaft that is responsible for the absorption of the light, which generates the heat that eventually disables hair growth. When hair growth is disabled, long-term hair removal is achieved.

(Left: Before treatment, Middle: During laser hair removal; Right: After treatment)

Both Silk’n and TRIA have safety features to make the user experience as safe as possible. Silk’n comes equipped with an applicator tip that has been designed so that a light pulse can only be emitted when the applicator is in contact with the skin. This eliminates the possibility of an accidental flash of light directly towards a user’s eyes. Silk’n also uses a very low but effective level of energy, up to 5 joules per square centimeter. The TRIA includes a neat, proprietary skin sensor that enables the user to test their skin prior to each treatment to ensure that the user’s skin tone is compatible with TRIA.

With a price tag of less than $1,000, Silk’n and TRIA can save you more than just the hassle and pain of shaving and waxing — but money as well. The average cost of alternative hair removal over a period of 10 years is estimated to run anywhere from $3,400 to over $7,000, whereas Silk’n and TRIA can be used again and again, reducing the overall cost* of lasting hair removal.