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

• Leave a comment... (0)

By Dr. Michael C. Pickart, M.D., F.A.C.S.

Breast Implants: Should I Wait Until I’ve Completed All My Pregnancies?

It’s up to you.

Many young women are interested both in breast augmentation and in having children. They frequently wonder…

• Are breast implants dangerous for the baby?
• Do breast implants create issues when breast feeding?
• Will the implants still look good after pregnancies?

My short answers:

• Among mothers with implants, breast feeding is safe for the babies.
• On the other hand, breast implants may decrease the chance (by about 5-10%) that a mother can successfully breast feed.
• Breast implants may improve chest appearance both before and after pregnancies and breast feeding.
• Ultimately, a patient must decide for herself after she has had a chance to consider the facts….

Here are my long answers, with all the facts:

A woman who is interested in breast implants and in motherhood should weigh the plusses and minuses of both options.

One school of thought is to do the surgery when you want it. If you want a breast augmentation now, then do it now! You might not have your children for another 5-10 years. Why should you go without the implants for that relatively long period of time?

Moreover, breast implants are safe for children. They do not contaminate the breast milk.

And implants may actually improve breast appearance after pregnancies and lactation. Often, women lose fullness in the upper halves of their breasts after children and breast feeding. In recent mothers, I frequently place implants to increase upper pole volume, and sometimes I add breast lifts to position the nipple properly. If a patient has already had a breast augmentation, then I usually need to perform the lifts (called mastopexies) only.

Implants are not, however, without some risks. Large implants can stretch nerves, especially the nerves that provide sensation to the nipples and areolas. If those nerves are excessively stretched, then the nipples and areolas can become numb. If the nipples and areolas are numb, the breasts might not produce enough milk. Nipple-areolar numbness is uncommon but not rare; about 5-10% of patients do notice some degree of numbness.

Another way that breast implants affect lactation is incision location. One of my favorite incisions for breast augmentations is from 3 o’clock to 9 o’clock around the lower half of the areola. However, I never use this incision if a woman intends to breast feed. I want to avoid severing any milk ducts that might be important for lactation. Instead, I recommend an inframammary incision (in the fold under the breast).

(By the way, I no longer do armpit or bellybutton incisions. These were both novelty incisions, through which I have never seen perfect results—either in my own patients or in anybody else’s. I am very fussy, and I am only satisfied when the breasts are perfect. With armpit and bellybutton incisions, the results are just too unpredictable.)

So, the bottom line: a patient must decide for herself….

• If you’d feel better about your chest appearance with implants now, then let’s proceed.
• You shouldn’t worry that you are putting your baby at risk.
• I’d recommend an implant on the smaller side (that will be less likely to cause nipple numbness).
• And we should agree that an incision in the fold underneath the breast will be safest.
• However, if you really want to maximize the chance that you will be able to successfully breast feed, then I must admit that we should wait until after your pregnancies; you’ll probably have a 5-10% greater chance of being able to breast feed your baby.

Visit Dr. Michael C. Pickart’s Plastic Surgery Message Board on Make Me Heal, where you can ask him questions about liposuction and get answers.

An accomplished plastic surgeon with expertise in both cosmetic surgery and reconstructive surgery, Dr. Michael C. Pickart (http://www.pickartplasticsurgery.com)specializes in all breast surgery procedures (breast implants, reduction, lift), body contouring procedures such as liposuction and tummy tuck, and has extensive experience in facial plastic surgery (i.e. facelift, eyelid surgery, rhinoplasty). Certified by the American Board of Plastic Surgery, Dr. Pickart previously served as a Clinical Assistant Professor of Plastic Surgery at Loma Linda University, where he has taught students and residents the principles of plastic surgery. Graduating from Stanford University with honors, Dr. Pickart trained with renowned plastic surgeons Drs. John Grossman and Philippe Capraro, in Denver, Colorado. Dr. Pickart graduated in the top of his class from the School of Medicine at the University of California, San Francisco, one of the most selective medical schools in the country.

• (0)

The virtues of breast implants have been widely discussed in both words and pictures, with breast augmentation patients often citing not only an improved physical appearance, but also a greater self-confidence and body image, better love prospects and more marketability in the job market. But virtually no attention has been given to a common problem that plagues a wide number of plastic surgery patients who undergo breast augmentations. In a poll conducted by Make Me Heal (www.makemeheal.com), 45% of breast augmentation patients admitted that they wished they got bigger breasts than the size they ended up with following surgery, while 14% wanted smaller implants than the actual size they got. Of the respondents, 41% said the breast size they received was the one they wanted.

Speaking about the problem of getting the right size breast implants, one patient nicknamed “domesticgoddess“ wrote on the Make Me Heal message boards, “I have moderate profiles and I wish I would have pushed for the high profiles in a larger cc volume. I thought I wanted that natural look but now I just want that perky upper pole fullness without having to wear a bra.“

A second patient with a username “connies“ said, “I went from a b to a double dd and now I am used to them. After 9 weeks I think I could have gone bigger!“

The problem of patients getting their breasts augmented to a size that they wished was bigger or smaller stems from the very fact that one cannot actually measure accurately the breast size they want to be. Moreover, breast implants are not like clothing, as one cannot actually “try on” an implant before deciding which size to get. While doctors will do everything to help patients better communicate the breast size they want by having patients bring in photos of women with breasts they desire, using digital imaging software to show patients the size they can be, or by having the patient put bags of rice in their bras at home, these methods do not lead to an accurate determination of what breast size the patient actually desires. As a result of these rough methods, women often find themselves getting breast implants that are smaller than the size they wanted. The only way to rectify this problem is to go under the knife a second time, remove the existing implants, and have bigger implants re-inserted. But the idea of having to get plastic surgery again is not appealing to most patients, who settle for their new breast size, despite it not being the ideal one they wanted.

Breast Implant Sizer Helps Women Get The Breast Size & Look They Desire

But there is hope apparently for women about to undergo a breast augmentation. In light of so many women with breast implants ending up having breasts that are not the size they wanted, Make Me Heal began offering this month the Breast Implant Sizer, a simple, yet powerful tool that enables women seeking to get breast implants to better visualize the breast size that they desire and to determine more accurately how many cubic centimeters (also known as “cc’s”, which are the measurement of implants) their implants should be. As over 50% of women today who have breast augmentations either have difficulty in figuring out exactly the size they should be or after having surgery wish they chose a different size than they got, Make Me Heal’s Breast Implant Sizer helps ensure that a woman will be able to get the right size that she desires with no regrets.

The Breast Implant Sizer comes with two implants that are filled by a syringe with water. The syringe has millimeter measurements, and 1 millimeter is equal to 1 cubic centimeter (this is the measurement used for determining breast implant size). As one fills the implant with the syringe multiple times, the patient simply needs to write down on paper how many cc’s one is adding each time. When a desired size is achieved, the implant is inserted inside the bra and the patient is able to visualize how the implant fits. The patient can walk around with the implant all day and get a more accurate visualization of how they would look and feel at that size. As the implant can go up to 600 cc’s, one can adjust the implant to visualize their new look in different sizes.

See the Breast Implants Sizer.

• (0)

Women looking for a minimally invasive, virtually scarless breast augmentation may find hope in a new and innovative procedure called Celution that has just gained approval in the European Union. The new plastic surgery technique achieves breast enlargement by injecting a supercharged fat mixture into the patient’s breast. Fat is taken from a woman’s stomach area, buttocks, or thighs using a minor liposuction-like procedure under local anesthetic.

Celution is not yet available in the United States, but it has been approved by the European Union for 2008. The technique will first focus on breast reconstruction for women who have had breast cancer and have undergone a partial mastectomy (breast removal) or lumpectomy. However, breast augmentation through the Celution techinque may be a possibility in the future.

Fat taken from the patient is placed in the Celution system, a device which separates out and concentrates stem cells and regenerative cells. About an hour later, a prescribed dose of regenerative cells are injected into the patient’s breast tissue. “It works by ’supercharging’ the fat cells, which makes them stay where they are injected”, explained Dr. Eric Daniels, senior director of business development for Cytori Therapeutics in San Diego, which developed the Celution technique.

Following the Celution procedure, breasts may enlarge up to two cup sizes over about six months, while also appearing more natural than with traditional breast augmentation procedures. One day, women seeking to increase their bust may be able to go in and have this procedure done during their lunch break, and of course, the bonus is that fat would also be taken from the stomach or thighs while one’s breasts are enlarged. Who could complain about that?

The use of fat injections in reconstructive procedures is not a new breakthrough, as it is commonly used in different cosmetic procedures for many years. Dr. Brian Kinney, a plastic surgeon from Beverly Hills, California and clinical assistant professor of plastic surgery at the University of Southern California, said that, “It’s become common practice for plastic surgeons to use [the patient’s own] fat in filling in defects such as around the eyes, in the nasolabial (nose to mouth) folds, and in the body, especially after liposuction that leads to irregular contours.”

However, breast reconstructions using fat injections have failed in the past because the patient’s body often reabsorbed the fat. With Celution, however, mixing fat-derived stem cells from the Celution system with the patient’s fat has apparently minimized this problem of fat reabsorbing in the body. “The supercharged fat graft survives really well and fills in the volume defect left by partial mastectomy,“ says Kai Pinkernel, Cytori’s Head of Research & Development.

Kinney, who is also past president of the Plastic Surgery Educational Foundation of the American Society of Plastic Surgeons stated that a procedure like Celution could be of benefit to women wanting a regular breast augmentation.

“It would not be surprising in the future — with refinement in technique — that this could be of benefit to women who need augmentation or reconstruction. But it may be many years, and it’s far too early to know before large, well-controlled case-control clinical trials are done and peer-reviewed by other experts,” says Kinney.

While Celution and stem-cell fat techniques of the like hold considerable promise for women seeking a minimally invasive breast augmentation that would not require the insertion of implants, the prospect of a one-hour procedure to achieve an aesthetically pleasing result that rivals a traditional breast enlargement surgery seems unlikely. Doctors believe such a procedure will likely need to take longer than one-hour to achieve desirable breast enhancement results. “Just a few years ago, lots of attention focused on the weekend face lift”, Kinney said. “A lunchtime breast augmentation is equally implausible.” Similary, Mac Hedrick, president of Cytori Therapeutics, said “No one is going to leave for lunch, have the procedure and go back to work like it’s no problem.” Hedrick expects the procedure to take two hours under general anesthesia. Additionally, the Celution technique has the limitation of not being able to increase one’s bust by more than two cup sizes.

Yet even if the procedure would take longer than lunch to perform, many prospective candidates seeking a moderate breast enlargement would likely flock to have a virtually scarless and silicone-free breast augmentation.

• (0)

Before	After One Month

Stem cells are becoming more widely used in plastic surgery for breast augmentations, as fillers for wrinkles, and to enlarge any body part where more fullness is sought. With the European Union and Britain having just approved the use of stem cells for cosmetic surgery this month, this move is likely to make the use of stem cells more and more popular worldwide and ultimately in the United States.

Stem Cells In Breast Augmentation

Stem cells have been used in breast augmentations since 2003, as Japanese scientists have pioneered a treatment that offers a natural breast augmentation that uses stem cells and fat derived from the patient’s own body to create soft and naturally augmented breasts. As no implants are needed and only self-extracted stem cells and fat are used, the patient’s enhanced breasts are essentially “real.” This procedure has been performed on 54 patients (for breast enhancement and facial rejuvenation procedures) thus far without any patients reporting any major problems. Already approved in the European Union and Britain, stem cell-assisted breast enhancement may soon become a reality in the United States.

One stem cell-assisted treatment can successfully increase breast volume by 120-160 ml (1 ml equals 1 cc), which is the rough equivalent of two bra-cup sizes (5 to 7 cm). For patients seeking to augment their breasts by 300 ml, the treatment needs to be performed twice. In both cases, no implant is used. For augmentations exceeding 300 ml, a combination of an implant and the stem cell technique is used to achieve the desired results.

Pioneered in Japan by plastic surgeon Dr. Kotaro Yoshimura (read Make Me Heal’s one-on-one interview with Dr. Yoshimura), the Cell-Assisted Lipotransfer (CAL) soft tissue augmentation technique claims to result in breasts that look and feel more natural and smoother without implants and the larger scars that accompany traditional breast augmentations using implants. The technique is performed by suctioning fat from the abdomen or thigh and then injecting the fat together with adipose-derived stem cells obtained from the patient back into the breast. The liposuctioned fat mixture, which now contains a high level of stem cells, is then transplanted layer by layer back into each breast to ensure an even distribution of the fatty mixture. What then occurs is that the stem cells enable the fat to grow its own blood supply, which leads to the fat becoming a part of the breast as opposed to a foreign mass. Some of the cells produce more fat and other cells change into a living blood supply for new breast tissue that grows into the treated breast. Unlike traditional breast augmentations, there are no incisions involved, as only small needle punctures are made on each breast that lead to tiny imperceptible marks (a detailed description of the procedure follows the interview at the bottom). Furthermore, enhancing one’s breast through the stem cell technique eliminates the risks associated with implants including deflation and leakage, capsular contracture (hardness and deformity), autoimmune disease (neurological problems), infection (skin redness and fever), and displacement (asymmetry and dislocation). Because the patient uses one’s own stem cells and fat, the CAL technique carries no risk of the tissue being rejected by the body.

The main drawback to the procedure is that breast volume can only increase 120-160 ml per treatment, with a maximum breast enlargement of 300 ml through two treatments. Additionally, very thin patients may lack an adequate supply of adipose fat.

Stem Cells In Facial Rejuvenation Procedures

Before	After

Stem cells are also being used to reduce and fill in wrinkles, repair damaged tissues, and help the skin regenerate itself and become more healthy and radiant. When stem cells are placed next to mature adult tissue, they can naturally repair the tissue and help it regenerate itself into new, youthful tissue. Dr. Richard Ellenbogen, who is among America’s leading face lift surgeons, has been using a patient’s own fat to restore volume and youthfulness to the face for over 25 years. Dr. Ellenbogen recently made the discovery that not only does fat help restore volume to aging and weak facial structures, but the fat also rejuvenates the skin because it contains stem cells.

“I first started using fat during my Volumetric Facelift to restore volume in patients’ faces over 25 years ago,” says Dr. Ellenbogen. “After years of working with fat, science has now revealed that the stem cells in fat reduce wrinkles and give patients radiant, glowing skin as well.”

Patients of Dr. Ellenbogen who had the Volumetric Facelift often said that their skin looked healthier and that wrinkles and pigmentation spots they had disappeared after the procedure. Since a face lift is not meant to erase wrinkles but rather treat the underlying structures, this added benefit was a welcomed surprise. Dr. Ellenbogen attributes the disappearance of wrinkles and the improvement in the skin appearance to the presence of the very rich stem cells found in the fat that has been injected into the face during the Volumetric Facelift.

Dr. Karl-Georg Heinrich in Germany has also been using stem cells for plastic surgery procedures. Dr. Heinrich says that “with stem cells we not only get 100% natural results - these will also last a lifetime.” Being that the stem cells are obtained from fat that is liposuctioned from the patient’s body, the patient is able to both lose fat and improve their skin at the same time.

With more surgeons finding that stem cells can be used to augment breasts and other body areas as well as act as fillers for wrinkles, the future holds great promise to patients who are seeking more natural ways to enhance themselves.

• (0)

Actress Halle Berry is lately having trouble finding head or tail of her story. Well, not so much story as a decision she is willing to announce to the public. And what else about than plastic surgery? Although she denies having a nose job done earlier, we find that hard to believe. From a picture taken in 1986 compared to one taken in 1997, she has a less wide nose and a more defined tip. In an interview with Reader’s Digest, she said, “I hope I will evolve as a person who realizes it’s really not about my physical appearance and not be drawn to that seductive knife.” She honestly does admit that if she will need plastic surgery in the future, she’ll do it.

She thinks beauty is meaningless and changes all the time so does not find the necessity for plastic surgery. She has always learned to tough it out on her own, ever since turning 21 and living in a shelter for a while when her mother would not send any money to her. This turned out to be the best lesson she has ever learned about life, and we’re glad she did. She was picked to have the nicest nose.

Halle is so against plastic surgery she has called any woman who has undergone it ‘insane.’ Instead, what she finds empowering is putting on the catsuit she had to wear for ‘Catwoman.’ She said, “Putting on that catsuit every day was empowering and it really helped me make some life-changing decisions.” She does not feel beauty has let her avoid any difficulties in life, such as heartache or even the struggle to survive.

Yet at the same time, she feels it’s important to do what makes a person feel good: “I’m not big on plastic surgery but I don’t fault it for someone who wants it,” she said. “You have to do what makes you feel good, but it’s not my thing.”

So,

Halle, what is it going to be? Have you had anything done or do you truly believe that getting something done would make you insane? Whatever you choose, staying strong through a financial crisis, surv