The technical term is ptotic breasts, according to WebMD.com,  and in this case, women aren’t looking for implants, they are looking for a breast lift, or mastopexy – a procedure that removes excess skin in order to lift up sagging or drooping breasts.  Whereas breast augmentation increases your cup size, the breast lift brings them back up toward your chest and away from your knees.

The problem is simple:  there is too much skin, the tissue is too low and the nipple is pointing southward. To get them back where they should be, a plastic surgeon removes the excess tissue and skin, sutures them into a new new position and moves the nipple up to its new location. There are two types of breast lifts: the concentric (doughnut) lift that is used with smaller, less droopy breasts; and the more common anchor-shaped lift. There are different techniques, too, and the surgery can even be done without moving the nipple in milder cases.

The two biggest drawbacks of the surgery are scarring, and losing sensation in the nipple for some period of time.  Scars usually run from the nipple down, in an inverted “T”,  so are not dramatic, but definitely noticeable.  When the nipple areolar complex is severed and moved, it will be sore and then numb for some period of time, depending on individual healing time.

The breast lift was the seventh most popular cosmetic surgery in 2009 and 19th most sought procedure overall, according to American Society for Aesthetic Plastic Surgery. It is sometimes done in conjunction with breast augmentation surgery. Lift surgery alone is done on an outpatient basis and takes from 1-3 hours. Gauze is removed after a couple of days and stitches are removed after about two weeks.  A surgical bra is worn for support, sometimes for several months after the surgery. Bruising, swelling and pain should be gone after 4-6 weeks, but it can take up to a year to completely recover.

Lastly, this surgery will not keep breasts perky as long as implants. Age, weight changes and additional will stretch them out again. Cost for the procedure averages $7,000-$9,000, depending on where you live and the extent of the surgery.

• iEnhance.com offers a list of 13 questions to ask a prospective surgeon before undergoing this procedure. If you’re not good at talking with a doctor, print the list and take it with you.

• Before and after pictures on LocateADoc.com give an idea of the results and also of the scarring you will see afterward.

• This short, minimally graphic video of a surgery by Greek surgeon Dr. Nodas Kapositas is a great example the process.  It shows just enough of the actual surgery to give an understanding without being difficult to watch. Bonus: funky music!

Brow lift: A surgical procedure in which the skin of the forehead and eyebrows is tightened to eliminate sagging eyebrows or correct frown lines in the forehead.

Also called a forehead lift, this procedure wipes your worries away – or at least those pesky worry lines that aging and stress tend to grant to many of us. Ranking 22^nd among all cosmetic procedures, the brow lift has only been around since 1995. There are several different types of procedures:

• “Coronal” involves making an incision at or just past the hair line and removing excess skin and possibly some muscle from the forehead area. A plus is that the surgery may result in a lower hairline, however, there could also be noticeable scarring.
• A newer approach is endoscopic surgery, which involves several smaller incisions as opposed to one longer incision. This surgery adds some time to the one- to two-hour procedure, but is less invasive and there is a smaller chance of temporary scalp numbness.
• A subcutaneous lift involves incisions made at the hairline and scarring may be visible.
• A temporal brow lift, sometimes called a lateral lift, involves pulling the skin horizontally rather than vertically, and sometimes results in an exotic, cat-like look, but may also eliminate crow’s feet or wrinkles around the eyes.

Brow lift surgery is sometimes combined with bletharoplasty (eye lift). Sutures are removed in 7-10 days. The average recovery time is two weeks, and the after-effects are swelling and numbness, which can also affect the eyes and cheeks. The cost for this procedure varies widely, anywhere from $3,000 to $8,000, depending on the type of procedure and area of the country you’re in.

RESOURCES:

• Here is a straightforward look that explains the different types and subtypes of this procedure.
• How about a video of an endoscopic surgery?  First pictures, then surgery footage.  It isn’t bloody – sort of like cutting up a chicken – but it’s probably not for the faint of heart. 

It gets worse.

Noses play a central role in many people’s self esteem. It is the focal point of our faces, second only to the eyes.  But you have to get beyond the nose to even get to the eyes, and if yours is larger than life or crooked as a creek, it is going to draw attention and probably affect the outcome of your psychological growth.  So the person gets a little obsessed – big deal?  But hypochondriacs, they say?  Well, if your nose is the size of Wyoming or the shape of a left-hand turn sign, a simple cold is going to be much, much worse, don’t you think?  And if you’re already obsessed with the damned thing and it doesn’t work right…well, you know what I mean.

But as I said, it gets worse.  As LookinGood went nosing around for more information on this peculiar psychological phenomena, we discovered that one of the side effects of rhinoplasty – aside from the pain and expense – is depression.  No one knows why nose job patients experience uneasiness or a slump after surgery.  Some say it’s the side effects of anesthesia, but I’ve never heard of a person getting depressed after an appendectomy, have you?  Others say it’s because of sleep deprivation – patients have to sleep sitting up for a couple weeks after surgery. A recent report from Pharmacology & Physiology in Anesthetic Practice, has a physiological explanation:  “Disrupting the sensitive receptors … which moisten and control the temperature of the air which you breathe … can lead to minor disorientation and depression for several weeks and sometimes months after rhinoplasty.”

Whatever the reason, it just seems plain unfair.  And at the risk of pointing out the obvious – why the hell did they name it “rhino”- plasty, anyway?  Conjures up the image of circus animals, for heaven’s sake!

All plastic surgery comes with some price, but this seems a bit much, I think.

So I say to to those people suffering the snide remarks and self-consciousness about their schnozzes; the mental anguish of making a decision about plastic surgery, along with the depression that might come as an after-effect, just remember these important words:

“It’s not the size of a nose that’s important. It’s what’s in it that matters.” (Steve Martin)  I hope that helps.

I exaggerate of course, but hand rejuvenation is a new specialty among esthetic professionals for good reason.  While the skin of the face and neck may get all the attention in the fight against aging, the condition of our hands are, as my husband pointed out – a dead giveaway.  No matter how fat your butt is, older hands lose their fatty tissue and look bony and wrinkled.   Hands are often the first thing damaged by the sun, which results in freckles and age spots.  Because they are always in water and being wiped off, skin on your hands is often dry and itchy.  Even the veins stick out more as we age.  Remember the hands of the Wicked Witch of the East?

You get my point.  If hands are your issue, you are not alone.

[continued from newsletter]

The solutions for regaining youthful hands are many.  Product-wise, Retin-A and glycolic acid can be applied to the hands topically, which cause age spots to fade over time, just like they do on the face.  Chemical peels and microdermabrasion are also prescribed for faster results, but will definitely keep you from doing dishes for a few days while your hands heal.  Retin-A products usually run about $60-$100 a tube; the skin resurfacing procedures cost $200-$500.

Processes like laser skin resurfacing for the hands are very popular in medical spas using Fraxel, Thermage, Refirme or IPL, which can remove spots and broken capillaries.  For larger blood vessels, physicians use the same technique they use for spider veins – sclerotherapy – during which a chemical is injected into the veins that causes them to shrink. Dermatologists are even using injectable fillers to temporarily plump bony hands.  Depending on the services you receive, expect to pay $1,500 to $5,000 for these types of treatments.

If you are VERY serious about your hands, you can also go in for soft tissue augmentation where fat cells are taken from other parts of your body and transplanted to your hands. Hand rejuvenation procedures like those usually take place under outpatient anesthesia and are upwards of $1,500-$5,000 as well.

Doctors can bundle the procedures to save you money, but hands down, cosmetic hand rejuvenation could turn into some serious ‘high fives’.

We all know that our faces change as we age, with “change” just being a nicer word than “sag.”  A new study led by physicians at the University of Rochester Medical Center, however, suggests that changing bone structure is as big a contributor to the problem as aging skin.

And this, my friends, is bad news for our boys.  Their future facelifts may not just be skin deep, but cut right to the bone.

That’s what Dr. Oscar Ramirez is banking on, anyway, touting his Mandibular Matrix Implant System.  It sounds like something from a Keanu Reeves science fiction movie, but really it’s just fancy words for implants to the entire lower jaw (a.k.a. the mandible).

The idea is to give men, and sometimes women, a stronger jaw line, enhancing the shape of the face and making it look younger.  Mandibular implants aren’t new, though as with most cosmetic procedures, advancements are always being made.  Dr. Barry Eppley, at exploreplasticsurgery.com, notes that creating a strong jaw is not simple.

The mandible has three sections, the chin, the body (side), and the jaw angle. Because this is an area unique to each individual, implants have to be custom-made in advance, or carved during surgery.  They can be done in one, two or three pieces. They are inserted through incisions at the bottom of the chin or sometimes through the mouth.  They are held in place with sutures and screws.   Often, a neck and/or jowl lift should be done at the same time.

Ramirez’s system “is composed of an articulated wraparound geniomandibular chin implant and a wraparound gonial angle implant,” according to the website, and appears to be two overlapping plastic pieces attached to each side of the face.  The accompanying picture looks like a skeleton wearing a heavy-duty chin strap.

And of course, this is considered cosmetic, which means no insurance.  The cost could range from $4,000-$10K.

This is some seriously facial engineering, here folks.  Really manly kinda stuff.  Women might be accused of taking our facelifts too lightly, but leave it to the guys to do it big.  No nip/tuck here, this is structural demolition and reconstruction.

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.

So what is it?  A good way to explain what it is, is to explain what it is not:  it is not a modern facelift.  Technically, facelifts require that the surgeon reposition and cut away muscle, fat and fascia, known as SMAS, under the skin of the face, then lay the skin over the uplifted muscle and cut away the excess.  That sounds simple and, of course, it isn’t, given that in order to correctly reposition the SMAS you must pull a good deal of the person’s skin away from the face first, cut and sew muscle, then sew everything back up without any scars.  When facelifts were first invented in 1904, surgeons merely pulled skin tighter, meaning the skin just looked pulled, and couldn’t possibly last as it stretched out again under the pressure of the sagging muscle. In some ways, according to physicians interviewed and on RealSelf.com, that is what the Lifestyle Lift is – minimal SMAS repositioning, if any, and mostly skin work.  Although the procedure can be done in an hour under local anesthesia, the results are not as long lasting since the underlying problem isn’t addressed.

Still, there are 40 different Lifestyle Lift clinics around the country, many doctors who do the procedure, and some satisfied customers.   Cindy P., from San Diego, told LookinGood “I’m glad I did it and don’t regret it.  Recuperation was not a problem… People tell me that they can’t even tell I had one.”  She adds, however, “that could mean it didn’t work or they never thought I needed one in the first place.”

The cost of the procedure is approximately $4,000-$5,000, half of what a full facelift costs, but getting solid information from the company about exactly what IT IS doing is next to impossible.  Dr. Karen Horton, a San Francisco plastic surgeon warns, “I am skeptical about any procedure that makes claims about fantastic results, without [giving consumers] details of the technique itself and the science behind the operation.  Buyer beware… “

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?

[continued from newsletter]

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.

Face it, whether you are male or female, aging’s a bitch and gravity is oh, so unkind. We gain weight, then start to sag. It’s unsettling for women,  but it’s even more awkward for men.  At least women have a number of options to counter the effects of sagging bosoms, including cornucopia of bras and other undergarments that offer support, and surgery is fairly commonplace.

[continued here from newsletter]

For men, not so much.  In a 1995 episode of “Seinfeld” Kramer and Frank Costanza tried to market the “Manssiere” or “Bro,” but that was TV satire from nearly 15 years ago and there are few men’s foundation garments on the market outside of some slimming T-shirts and a bra for men sold in Japan.

Gynecomastia is breast reduction surgery for men. It is not cutting or lifting, but actually the liposuctioning of excess tissue from the chest, magically turning those man boobs back into the shapely pectorals they once were. The surgery itself lasts about two hours and you’ll need a week of downtime before you can get back to work and your other regular activities.  It’s the fourth most popular plastic surgery among men (behind regular lipo, rhinoplasty and eyelid/brow lift), and ranks 12^th overall among cosmetic surgeries performed in 2008 (2009 results are not in yet.)

Of the 800,000 cosmetic surgery procedures performed on men that year, 19,124 were breast reductions, according to the American Society of Plastic Surgeons (surgery.org), which was down significantly from 23,670 in 2007.  The decrease in demand for gynecomastia could be an effect of the poor economy.

At the same time, not quite half (47 percent) of the reviewers who shared their experience were satisfied with the procedure.  The average cost for the surgery hovers in the neighborhood of $5,000, depending on where you live, and it has come down slightly in recent years.

Before thinking about surgery, however, men who are experiencing enlarging breasts need to find out why. It could be age or weight gain, but it could also be due to hormonal changes (a side effect of aging in all of us) or a reaction to a medication. Once you know the cause, it is easier to weigh your options.