When I lost 35 pounds five years ago, I didn’t know any of those things.  Granted, 35 pounds isn’t even going to put me in the top 100 on “The Biggest Loser,” but it was still significant enough to be nearly 20 percent of my body weight, and I wanted my six-pack, dammit. I knew my abs were under there, but eventually I realized that after a decade of extra weight and popping out a couple of babies, that skin wasn’t going to snap back in place.

You can lose weight, but you can’t lose the skin without help as “The Doctors” told Season 8 Biggest Loser Danny Cahill.  And that can be done through tummy tucks, breast lifts, arm lifts, thigh lifts and the more extreme body lifts (upper: breast, chest and middle back; lower: abdomen, buttocks and thighs).

According to emedicinehealth.com, a patient may require from 1 to 6 of the procedures to achieve his or her desired look.  It also lists the pros and cons of the body lift procedures: “Advantages of body lifts include improved skin quality, long-lasting results, smoother natural contours, and better control of results. Disadvantages of body lifts include more complex surgery (requiring more expertise), longer operating time, long scars, longer recovery after surgery, and increased cost.”

Although losing weight is a significant health-care issue, getting rid of the skin that’s left over is not. At that point, procedures are usually cosmetic, so odds are, insurance is not going to cover them. Surgery is going to be expensive (think beyond $10K) and, well, it’s major surgery. For the body lifts or multiple procedures, recovery time is significant: 1-3 nights in the hospital and then months before you can get back to regular activity.  Your body also has to be well enough to handle the surgeries in the first place, maintaining a stable weight and not suffering any of the health issues that sometimes accompany significant weight loss, such as nutritional deficiencies (low folate, B-12 and/or iron).

In fact, considering all you’d have to go through to get rid of the extra skin once you’ve lost a lot of weight, that might be incentive to stay trim in the first place.  Print before and after pictures and details about the surgery on those Twinkie packages. That could be an effective deterrent.

• The American Association of Aesthetic Plastic Surgeons has good information about the different skin removal procedures.

What IS surprising though, is looking at the statistics by gender.  Maybe boys don’t cry, but they do nip, tuck and inject, and the numbers grow slowly, but steadily each year.  Cosmetic procedures among women dropped nearly 3 percent overall in 2009.  Among men, however, they rose almost 8 percent from 2008.

As a whole, the plastic surgery industry saw a 2 percent overall decline in 2009, and after the 12 percent drop in 2008, that’s probably a small victory.  It was a $10.5 billion industry last year, but number of surgeries performed, such as breast augmentations, nose jobs and tummy tucks, continued to fall, as more and more consumers are opting for needles and lasers over scalpel and stitches. In fact, the only surgical procedures that saw an increase were butt lifts and butt augmentation.

Nonsurgical procedures – which include injectables, facial rejuvenation such as dermabrasion, and some laser treatments – rose overall by 0.6 percent. And the demand for good ol’ Botox and Dysport (classified as Botulinum toxin Type A) was up nearly 4 percent over 2008, with 2,557,068 performed in ’09.  The ratio of surgical to nonsurgical cosmetic procedures is now 15:85.

It’s still predominantly a women’s market, but men now account for more than 9 percent of all procedures and 10 percent of nonsurgical procedures.  And you can drop the tailgate on the Botox bandwagon, because here come the boys.  The number of Botox treatments for men were up 23 percent over 2008, and all nonsurgical procedures among men rose 11 percent, huge numbers in an economy sagging more than Ben Stein’s face.

So, now we know that not only is men’s grooming and personal care a growing market, but so is plastic surgery.  Guys appear to be moving away from their knuckle-dragging Cro-Magnon ancestors, removing body hair, lifting brows, reinforcing hairlines and smelling better, which is all good.  Now, if we could just get them to put the toilet seat down.

Say you want a fuller face.  A surgeon sucks out a little fat via needle and syringe or cannula from your belly or hips, then injects it into your cheeks or lips, smoothing wrinkles and restoring a youthful plumpness.  Since the cells were yours to begin with, there’s no chance of allergic reaction or rejection.  Sounds like stealing from the rich and giving to the poor, doesn’t it?

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Still, fat grafting is the lowest rated procedure at RealSelf.com, primarily because of its unpredictability.  Fat is living tissue and has to be kept alive to properly plump its new location.  Fat grafting involves harvesting, processing and re-injecting, and some of the fat cells are going to die during the process. The question is, just what percentage will become useless.  As one plastic surgeon on RealSelf put it, it is highly dependent on technique.  Another variable is that the fat could be reabsorbed into your body, and the so-called experts can’t seem to agree whether the results are permanent.

Additionally, if you want to kick up a little controversy, get a few plastic surgeons together and ask about fat transfer for breast augmentation. In 2007, the American Society for Aesthetic Plastic Surgery and the American Society of Plastic Surgeons came out against the procedure for breast enlargement, because there is little or no data that shows it is better or safer than using silicone or saline implants.  Some doctors also argue that if the transferred fat dies, it can leave behind scar tissue or calcifications. It can also hamper cancer screenings, and it remains a hot-button issue..

From people who have had it done, however, especially in their cheeks and hands, fat grafting usually wins high praise.  Some recent studies show that because the fat is rich in mature stem cells, fat grafts to your face and cheeks may improve your complexion.  It is outpatient surgery, requiring a day or two of downtime to allow the harvest sites to heal.    The cost of the procedure varies widely, not only by region and surgeon, but also depending on where you having the injections (lips will be less than butts).

For more information, PlasticSurgery.com is a good resource.

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Stem cells are known to regenerate tissue and repair damage.  The controversial part is that stem cells with the most potential for serious medical treatment are embryonic in nature, and that poses ethical problems.  But now, clinicians are testing the results of using a person’s own fat-derived stem cells in various cosmetic treatments to reconstruct and rebuild lost tissue in less invasive ways. Injecting adult stem cells into the face can make pores become smaller, and make general skin tone fuller brighter and fuller.  Fat grafting, which has always been problematic because of uneven reabsorption issues, becomes less problematic when stem cells are added.  It seems to cause the fat to stay in place longer and even generate new cells. Who knew? Fat could be the gift that keeps on giving!

Plastic surgeons have high hopes for stems cells, too.  The Stem Cell Facelift is a new procedure being tested in the European Union and Japan, where physicians inject the patient’s own stem cells into the wound of the facelift.  Reports claim that with the addition of the cells, healing is quicker and the results of the facelift continue to improve as the new cells keep regenerating.  For breast reconstruction, using fat that has been enhanced with stem cells may replace the need for silicone or saline implants.

Don’t get too excited – the FDA has yet to weigh in on this and much more research has yet to be done in the U.S.  Of course, that hasn’t stopped the cosmetic companies from capitalizing on the concept.   Never mind that real stem cells could never be put into products because they would die immediately.  Several anti-aging creams are targeting stem cells in the skin for repair, using plant stem cells – specifically from apples – as ingredients and producing conditions “around existing stem cells” that would cause them to grow.  You can bet there will be more products, and soon.

The most unusual product we’ve seen is C’ELLE, a $500 system for capturing your own stem cells from menstrual blood and sending them to the company for preservation of up to a year ($99 for each subsequent year.)   Someone isn’t all that keen about this idea, though. “The C’ELLE service is not currently available to New York state residents.”

Do we have something to thank Andrew Cuomo for again?

• MakeMeHeal.com published a fairly extensive review of the Stem Cell Facelift.
• Stem cells basics, including the use of adult cells, can be found on the National Institute for Health website.
• How the fat-derived cells are harvested is no small matter, as this doctor explains.

How about Brazil? Or Lebanon? Southeast Asia is big with the Brits.

Yes, cosmetic tourism (psst, that doesn’t mean visiting the Estee Lauder factory and outlet) is incredibly popular internationally and gaining attention in the U.S. In fact, Brazil and Lebanon are getting so popular, those destinations are beginning to market themselves as “Nip/Tuck and Tan” destination spots. Come for the surgery, stay for the sand and sun.

There’s no question the United States is and will remain the cosmetic enhancement capital, but the same surgeries done overseas can cost 50-75 percent less. That’s like getting the implants and throwing in a rhinoplasty. Of course you have to factor in the cost of traveling, but it’s just one more vacation activity. Whale watch? No, I think I’ll try the water-liposuction.

Also on the plus side, more surgeons in other countries are becoming as skilled as their counterparts in America.  They would argue that they always have been and we’re just becoming more aware of it. And of course, if you go on “vacation,” who’s to know you “had a little work done”?

“Golly Gina, it looks like Rio was really good for you! You look so well rested … it’s taken years off your face!”

The Brazilian plastic surgery biz took a bit of a hit in February when Tameka Foster Raymond, the wife of R&B singer Usher, went into cardiac arrest before liposuction.  But that was coming on the heels of the black eye the industry took in November of 2007 after the death of rapper Kanye West’s mother, Donda, in California.

Both women were poor candidates for the procedures they were having – Foster Raymond recently gave birth and West had a history of high blood pressure and a family history of heart disease.  As it turns out, neither incident seems to have had a chilling effect on the number of people going under the knife.

Those incidents do underscore the importance of doing your homework – knowing the risks of the procedures and picking an experienced, qualified surgeon, be it in Brazil or the Hills of Beverly.  A quack is a quack in any language.

So I’m putting myself out there, too.  If People, or any other magazine, wants to chronicle (and pay for) my transformation, here is my wish list as compared to Heidi’s:

Wait!  Only ten things?  What about a tummy tuck?  The excess skin on my arms?  My bunions?

Well, I will settle for whatever People Magazine will support.  Time-Warner, I await your call.

SmartLipo: (as opposed to DumbLipo?) Also called Laser Lipolysis, this treatment melts fat and destroys fat cells from targeted areas.  Using a small incision to insert a small tool that “washes away” fat, the procedure has very little downtime because the liquefied deposits are flushed out through normal bodily functions.  According to Realself.com, of the 400 people who reviewed the procedure from all parts of the country, more than 70 percent were happy with the results.  Depending on the size of the body part, the cost ranges from $3000-$8000.

Body Thermage:  Thermage is a minimally effective technology previously used on faces for non-invasive uplifts.  Reinventing itself as a body contouring procedure, Thermage uses radio waves to heat the collagen in deep tissue and firm it up.  The idea is a bit like cooking a chicken breast – raw chicken is loose and flimsy, cooked chicken is solid and firm.  If only it really worked that way.  Of the 175 Realself.com reviewers, only 38 percent thought it was worth it.  In the spirit of full disclosure, this sucker, er, reporter tried Thermage on her face a few years ago and experienced minor results.  Costs range from $1500-$4000, and I’m not telling you where I fell in that spread.

Zerona: LookinGood previously reported on this procedure and despite the publicity it has received from Rachel Ray, the verdict on its efficacy is still out.  Realself.com has only 14 reviews of Zerona, for instance, and so far they aren’t great, with headlines like “the only thing that got thinner was my bank account.”  Zerona is a space-age looking external device that allegedly puffs up fat cells making them more porous; the body then excretes the fatty cells.  You need 4-6 visits to the doctor for a full treatment, and it should reduce your bank account by about $2500.

VASER Lipo:  This one is a new one for LookinGood. VASER is an acronym that stands for Vibration Amplification of Sound Energy at Resonance, and utilizes, of course, sound waves. Similar to SmartLipo, a tiny tool is inserted under the skin that emits ultrasonic waves for emulsifying the fatty cells in small areas.  VASER, however, can be liposuction – it sucks out the fatty cells like traditional lipo, or the area is massaged so that the cells are absorbed into the body for normal excretion.  VASER Hi Def is a procedure that appears to be a contouring tool for men, where the device is precisely focused around targeted muscle groups, giving the muscles more visual definition from lack of fat (take a look at this picture.) Sound Surgical Technologies says that more than 100,000 people have tried VASER, but Realself.com reviews are almost split 50/50.  Again, depending on the size of the area treated, the cost runs from $2000-$10,000.

LipoLite: Last, and perhaps the least, LipoLite is described by American Health and Beauty as “a tiny incision … into which a precise and powerful laser beam liquefies fat cell deposits.”  Sounds familiar, doesn’t it?  What makes this different from SmartLipo is that the device is made by a different company and used on smaller areas of the body, like the neck or face.  We urge caution here, however.  There are very few reviews and at least one plastic surgeon who calls it a gimmick.

Body contouring has proven to be safe, effective and worthwhile to hundreds of thousands of people.  Do your homework, though. Or, just Ask LookinGood!

I’ve seen what old-fashioned Lipo looks like.  First, it’s an overnight stay and the patient goes home with drainage tubes coming out of them, which remain for days.  Second, the bruising looks like he/she has been thrown off the Empire State Building and lasts for months.  Third, you have to wear some weird girdle thing for weeks if you have anything done from the waist down, which evidently is where most people take aim.  And fourth, despite what anyone says – people complain that it hurts.

I have to admit that the results looks great, though.  Love handles transformed to love pinches, bellies flattened, thighs reshaped.  So, if there’s an easier way, I’m all over it.  Or, maybe it’s all over ME!

• A good explanation, albeit a little corny in spots, comes from The Miracle Image Medaesthetic Institute in Las Vegas.
• If you want to see what the FDA says about the new device, go to www.fda.gov, search for “water liposuction” and click on the pdf document titled “August 13, 2008.”
• Probably the goofiest propaganda piece t I have ever seen for what could be a decent product, is produced by Body Jet™ themselves and can be seen on YouTube.

Liposuction: A cosmetic procedure in which a special instrument called a cannula is used to break up and suck out fat from the body. This procedure is also known as lipoplasty.

For more than a decade, liposuction was the most popular cosmetic surgery in America until being dethroned in 2008 by breast augmentation, according to statistics compiled by the American Society of Aesthetic Plastic Surgery. It is still the most popular surgery among men, and ranks 10th among all cosmetic procedures.

Liposuction is a major physical undertaking for your body. In addition to the fat removed, blood vessels, lymph channels and connective tissue are all affected and the body needs time to readjust, reproduce and heal. You will be bruised and look and feel battered for weeks, and swelling can last for months after the surgery. Compression garments hold everything in place as you heal and guard against “rippling.”  Overall recovery time is related to the area affected and how extensive the surgery was. The most popular areas — abdomen, waist and thighs — have the longest recovery time.

In 2008, 18 percent of the more than 340,000 liposuction procedures in the U.S. were what is called ultrasound-assisted lipoplasty (UAL, also called ultrasonic or VASER). The idea is that the ultrasound waves break up the fat, allowing it to be more easily removed from the body. There are no clear studies, however, that show a significant reduction in recovery time. An emerging treatment is water-assisted liposuction (WAL), in which water is used to break up the fat. This procedure is able to suction out more fat at a faster rate and may reduce blood loss and recovery time, though there are no conclusive studies yet.

The cost of liposuction ranges from $1,500-$15,000 depending on location (both on your body and where you live), type of procedure and how much fat is removed.

• This gallery of photos shows before-and-after pictures of every area of the body on which liposuction can be performed.
• Video in Spanish: http://www.youtube.com/watch?v=XQfxyt9bg1k&feature=related
• This article is about plastic surgery for men, but gives a couple of interesting tidbits about liposuction for the male of the species:  http://www.askmen.com/sports/health/13_mens_health.html