SEATTLE, WA–(Apr 12, 2012) – Is cellulite about to be zapped into submission? A minimally invasive laser-based treatment known as Cellulaze™, created by Cynosure, Inc., was recently approved by the FDA and is piquing public interest as a new procedure against stubborn fat-dimple deposits. On RealSelf.com alone, the largest website for plastic surgery reviews and information, more than 40,000 people searched for Cellulaze on the site in March 2012, compared to just over 1,000 people one month before.

To help shed light on this new treatment as interest spikes, RealSelf gives the inside scoop on the top 10 Cellulaze questions asked on its site. RealSelf.com is not affiliated with Cellulaze or Cynosure, but is an unbiased website that tells the “real story” behind hundreds of plastic surgery and cosmetic procedures, as reported by patients who have them done, and the board certified doctors who perform them.

1. Does it really work? According to Cellulaze reviews on RealSelf.com, yes. The procedure scores a 100% “Worth It Rating” by reviewers who have undergone the treatment, meaning they would all do it again. One user wrote, “So far I am shocked at how different my thighs look. I really look like a new person!” Dr. Grant Stevens of Marina Del Rey at Marina Plastic Surgery Associates, who is a respected plastic surgeon active on RealSelf.com and early Cellulaze practitioner claimed, “I’ve seen it, I’ve touched it, I’ve examined it. It works. It’s phenomenal.”

2. What does the procedure involve? After numbing the area, a small laser tube is inserted under a patient’s skin. The laser heats up to melt lumpy pockets of fat, then cuts through the fiber bands that pull the skin and cause dimples. The laser then heats the skin to trigger new collagen growth, leading to better elasticity and thickness. The procedure must be performed by a trained practitioner, as Dr. Stevens notes, “It’s technically demanding.”

3. What makes it different from other cellulite “cures?” As posted on the RealSelf.comCellulaze Q&A board by Sacramento plastic surgeon Dr. Andrew Kaczynski, M.D., “Alternative non-invasive cellulite treatments only address the external effects of the skin but don’t address the core biology causing problem areas. Creams and massage are quick fixes with sub-par results. Cellulaze is the first technology that goes directly after the actual biological structures causing cellulite.”

4. What are the expected results? Reviewers on RealSelf.com reported saying goodbye to some cellulite spots almost immediately, and the manufacturer claims results further improve over the following 6-12 months. Dr. Stevens speculates, “I think what’s going to happen over the next year is we’ll hear more and more about doctors doing the treatment combined with liposuction, which actually sucks out some of the fat, for maximum results.”

5. How many treatments do you need? Is it permanent? Scoring points as a “one and done” procedure, Clinical studies have shown one Cellulaze treatment can keep cellulite spots at bay for a year or more.

6. Can I see Cellulaze before and after photos? Un-retouched before and after photos submitted by physicians are found at www.realself.com/cellulaze in the Photos section.

7. Will it hurt, and what is the recovery time? The procedure is performed under local anesthesia, and according to RealSelf.com reviewer NYTennis, she “felt some needles initially and some pinching with the numbing procedure… there was some nippy feeling here and there with the laser.” Another reviewer scored it as a low “1″ on a 1-10 pain scale. In terms of recovery, patients are said to be able to return to normal activities in one or two days, but may experience immediate light bruising and swelling to the treated area, as evidenced by NYTennis’ Cellulaze results picture, which reportedly clears within a week or so.

8. How much does Cellulaze cost? RealSelf.com reviewers reported spending an average of $5,700 per cellulite busting treatment.

9. Who is a good candidate? Cellulaze is said to deliver the best results for people who are not significantly overweight, but who have moderate cellulite on their thighs, buttocks and hips.

10. Where can I find a qualified doctor near me who performs the Cellulaze procedure?Visit www.realself.com/find as a starting place to locate and read reviews of nearby board certified doctors who specialize in cellulite treatments and may offer Cellulaze. (Or just call (916) 925-5522!)

To read more Cellulaze information from the RealSelf community, visit www.realself.com/cellulaze.

About RealSelf
RealSelf is the most visited online community for learning about and sharing information and results for medical-beauty treatments. Dedicated to helping people make suitable and empowered elective decisions, the site features consumer reviews, Worth It ratings, pricing information, and thousands of before and after photographs that collectively tell the ‘real story.’ The site also includes safety information and a Q&A with more than 3,500 board-certified doctors so visitors can interact with qualified experts and make safe decisions. RealSelf covers thousands of topics ranging from cosmetic dermatology to plastic surgery, cosmetic dentistry vision correction and more. www.realself.com.

Cellulite has always been the holy grail in the area of cosmetic surgery because while a lot of products say they are a solution, most women after trying many creams, lotions and other devices, understand there has never been a truly effective way to reduce it once and for all. These Cellulaze before and after pictures are amazing.

“Cellulaze is the world’s first and only minimally invasive medical device designed to treat women
who have struggled to eliminate cellulite through diet and exercise, or have tried the myriad of
lotions and creams currently on the market,” said Cynosure President and Chief Executive Officer
Michael Davin. “Unlike those products, Cellulaze is the only aesthetic device that directly treats the
physiological structure of cellulite, providing clinically proven, results.”

Cellulaze reduces cellulite – in just one treatment – by restoring the normal structure of the skin
and underlying connective tissue. Cellulaze diminishes the lumpy pockets of fat, releases the areas
of skin depression typifying cellulite and increases the elasticity and thickness of the skin.
Nearly four years of clinical research puts Cellulaze in a class of its own: the only single-treatment
aesthetic procedure clinically shown to reduce cellulite. Clinical data has demonstrated that
Cellulaze treatments can increase the thickness of the skin by 25% and increase the elasticity of the
skin by 29% at one year. No other anti-cellulite treatment has been proven to deliver these results.

Cellulaze uses a proprietary SideLight 3D™ side-firing technology to target the causes of cellulite
beneath the skin: herniated pockets of fat, stiffened septae and thin skin. During the procedure, a
tiny laser fiber is inserted under the skin, which gently heats the skin and disrupts or melts the fat.
Next the laser releases the fibrous bands that create the dimpling effect from pulling down on the
skin. This release creates a smoother look. Finally the laser’s energy stimulates collagen production
to increase skin’s thickness and elasticity for a more even, healthier appearance.
Patients usually see improvements within a few weeks, with the most significant results continuing
to develop for a few months following the procedure. Cellulaze also complements other body
shaping technologies, such as Cynosure’s Smartlipo™ family of workstations.

Learn more about Cellulaze offered by Advanced Concepts in Plastic Surgery by visiting our Cellulaze page and then schedule your consultation to see if you are a candidate! Bikini season is coming soon!

I recently found a little straight-forward article by a husband and wife plastic surgery team out in Columbus Ohio who summed it all up very nicely. Drs. Christine and Michael Sullivan of The Sullivan Centre are certified plastic surgeons and this is what they wrote:

The SmartLipo TriPlex is the 5th generation of SmartLipo and is exclusively offered in Northern California by Dr. Andrew Kaczynski at Advanced Concepts in Plastic Surgery.

SmartLipo is a brand name for a laser assisted liposuction technology developed and manufactured by Cynosure in Europe. SmartLipo TriPlex is the lastest, 5th generation of the SmartLipo brand. After more than six years of Cynosure trying to sell me the SmartLipo technology, after consideration of all the data, I have determined that the SmartLipo TriPlex is indeed a better mousetrap. I am now the only certified plastic surgeon in Northern California to offer this better and safer SmartLipo TriPlex liposuction technology. Liposculpture with the SmartLipo Triplex has proven to be even more effective, with better results than I had even hoped for! If you are researching SmartLipo or liposuction techniques, make sure you ask any doctor you speak to which generation of SmartLipo they are offering and if their laser lipo technology has a temperature monitor auto shut-off.

I have been performing liposuction since it was invented by Dr. Illouz in the 1980s. During all those years, different Liposuction methods emerged, such as Tumescence, Superficial, Power-assisted, Ultrasonic (VASER) and Laser Liposuction. Initially Laser Liposuction was experimental and not very practical. As the machines got better so did the results. However, it was still time-consuming, potentially dangerous because of burns due to lack of temperature control, and results were not noticeably different from previous, and I believed, safeer methods.

The ideal liposuction treatment would involve the smallest incisions, remove large amounts of fat, have minimal bruising, rapid healing, and would shrink the skin in the areas where fat is removed. It would also be safe and consistent . For years, the method closest to this standard was Ultrasonic Liposuction, or the VASER. At the time, there were many different Laser Liposuction systems such as and they all claimed to be the best. However, they were still time-consuming and had the risk of burning due to the lack of control over the lasers energy. That is, until Cynosure came out with SmartLipo TriPlex.

The current generation of Smart Lipo is the fifth generation of Cynosure’s technology. It provides three different laser wavelengths(1064, 1320 and 1440). This does make the system more complex, but much more effective: One wavelength decreases bruising, one increases fat melting, and one increases skin tightening. The biggest change as far as results are concerned, is the fact that there is significant additional skin shrinkage compared to previous systems. This is especially important in problem areas like arms, neck, inner-thighs, and abdomen.

SmartLipo now also leads to less trauma and faster healing. Equally important is the fact that this system has a temperature guide. In the past, the surgeon had to either feel the skin, or use a temperature gun to check the outside temperature. This new system has an internal temperature control which is an important safeguard to prevent excessive heating and the possibility of thermal damage.

The Smart Lipo Triplex machine is the next big thing in body contouring in terms of fat removal, skin tightening, and safety.

But what if the problem is not loose hanging skin, separated muscle and a blob of fat in your lower abdomen? For some women especially over 40, the problem is loose skin above the belly button. The skin lacks elasticity and just starts to form several rolls. ln the past these patients either had to have a full abdominoplasty with a the lot of pull or couldn’t have anything done.

Sometimes the non-invasive Thermage Skin Tighteing can help tighten up the skin in mild cases.

Now there is a procedure that takes care of that. With the reverse abdominoplasty an incision is made just under the breasts in the fold and across the entire abdomen in a horizontal manner. A small dart is placed in the midline to interrupt the scar for better healing. Then the skin is lifted possibly after some Vaser liposuction. This listing goes down to the belly button. The skin is pulled up just as I’ve seen patients show me on themselves many many times with their hands on their upper abdomen pulling up. “Why can’t it look like this?” The excess is marked and trimmed usually from one to 3 inches.

The underside is sutured with quilting sutures to hold it and prevent excessive tension. Then it is sewn in with special zipper type sutures which achieve barely noticeable scar. The procedure is very comfortable postoperatively and has much less downtime than a full abdominoplasty. lt also does not limit the type of bathing suit afterwards. This is because there is no scar at the hip. With a conventional tummy tuck, even with a selection of the scar curving up or down or straight across this area places limits on future bathing suit styles.

lf you’re a candidate it’s a quick and straightforward procedure to improve upper abdominal rolls and loose skin.

The worst problem however is inadequate pain control. In the end, some patients simply feel more than others for reasons that are not clear. So some patients undergoing these awake surgeries will not know that they are going to feel significant pain until the pain starts. Once the patient has been giving the limit of local anesthesia and they are still experiencing extreme pain, two things can happen. Number one, the doctor continues and tries to ignore the patient’s screams, or, when the screaming is too much to bear the doctor stops and does an inadequate removal which will likely need to be repaired by a real Board Certified plastic surgeon.

In breast implant cases, this technique allows the practitioner to put the implant under the breast but not under the muscle. In order to release the muscle, which allows the implant to be inserted under, it takes general anesthesia. With an inadequate muscle release, the implants never settle and can often take on a funny shape. The article cites one case in Las Vegas where an implant actually began to work its way back out of the incision days later! That patient ended up needing emergency surgery where it was discovered that the doctor who placed the implants had done a butcher job on her and even left some random sutures in the pocket.

The other disturbing issue for these procedures is the amount of time they appear to take. Although technically it is safer to do a longer procedure under local then the six-hour limit which we accept for general anesthesia, there is no reason to keep the patient on the table for eight hours or spread a simple liposuction into two or three days which is apparently what these doctors do. In my hands a three area liposuction takes about three hours under anesthesia. A breast augmentation takes about 45 minutes. There is no reason at all why these should be expanded to eight hour torture sessions but for some reason, the skill levels or the difficulties presented by trying to do these surgeries under local appear to expand the surgical time by a factor of four.

Why is there this new interest in awake surgery? Well there are several reasons. Number one to do the awake surgeries you don’t need an operating room. You can do it in any old exam room. Number two it opens up the procedure is to family doctors, gynecologists, internists, and emergency room doctors who are struggling financially with insurance reimbursements. It doesn’t matter if they have often minimal or no surgical training or background. Number three monitoring of operating facilities is based on the level of anesthesia. So in other words, the less anesthesia you use for your procedures, the less oversight there is.

That is to say, if you have an M.D., you can do any surgical procedure in your office including a heart transplant if you do it under local. As soon as you do some sort of sedation you are subject to accreditation and oversight. Most of these offices that do awake procedures would never survive scrutiny in the light of day. Tiny cramped operating rooms, (and I use that term loosely), which are subject to contamination, lack of sterility, lack of gowning by the so-called surgeon and his staff are all issues. There is no accreditation or peer review. There is no one looking at these dirty deeds done dirt cheap.

Then what happens after the patient heals from the procedure. I just did a four hour liposuction revision on the patient who was the second experiment of her gynecologist who had just “learned” how to do liposuction. On-the-job training so to speak. This patient had a symmetric mounds of fat on the front of her abdomen as well as depressions and unevenness. Under proper sedation with an IV and a nurse anesthetist, the patient was extremely comfortable. She didn’t have to have a tube in her mouth. And I had to redo everything which was more difficult than if I had seen her initially without any previous surgery. On top of that she had major asymmetries which had to be adjusted and needed fat removed certain places and placed into others. Lastly because she had so much rippling and wrinkling in her upper abdomen I had to do a reverse tummy tuck with incisions under the breasts. Fortunately, everything went very well and she had an excellent result. It’s too bad that she had to have two procedures to get to that place. It would have been easier for me and cheaper for her if she had just come to me in the beginning.

I think everyone considering plastic surgery should read the article from Self Magazine. They should also realize that for all the posturing done by people that promot it, it is not about safety and it isn’t about the well-being of the patient. It is about a group of unqualified untrained unscrupulous physicians trying to cash in on the demand for plastic surgery. Is there a place for awake procedures? Of course there is. I do some minor procedures and small revisions under local. These procedures are brief, the can-do anesthesia is excellent and everything goes well. There is no place in modern plastic surgery for eight hour torture sessions. Research your physician and the facility well. It’s a jungle out there and it’s full of predators just waiting for the unsuspecting patient.

What is Wired referring to when they refer to “natural breasts?” The story talks about the renewed interest in fat grafting as an option for breast augmentation. Fat grafting for breast augmentation means plumping up a woman’s breasts with her own fat that is transferred from another part of her body rather than using silicone or saline breast implants. Just the other day I posted a press release that highlighted a recent study I took part in that showed the VASER liposuction system is ideal for this very purpose. Essentially, the story is the tale of a bio-tech start-up company called Cytori. This company is getting into the tissue engineering business via stem cells harvested from fat and are doing so by starting with breast augmentation.

Why breasts? Theoretically they are simple to build since they consist of only one type of tissue which is fat. Nobody’s talking about actually building mammary glands that secrete milk. It’s all about form and not function. Attempts were made beginning in 1980s to do augmentation with fat. They had mixed results, mostly due to the fat not surviving and just being absorbed by the body. There were many different techniques and many different technologies applied.

This new story begins with a UCLA plastic surgeon Mark Hedrick who wondered if fat had stem cells. In fact it does. Approximate one stem cell per 100 fat cells versus one per 250,000 to 400,000 in bone marrow. Stem cells are the darlings of cell biology. Theoretically they can be used to make any tissue. They also release substances which improve healing and regeneration. Cytori reasoned that if you separated stem cells from the fat, purify them and added them as a concentrated extract to more fat than the combined stem cell plus fat graft would take better. They ran two successful trials in Japan. One on reconstructing partial mastectomy another on breast augmentation. I actually have the opportunity to hear the investigator Dr. Karushima present his work. He successfully implanted approximately 100 mL per breast for an increase of 1.6 cupsizes his Japanese patients.

The rest of the article talks about the potential for these stem cells including heart and other organs. So is this the next big thing? Well it certainly could be for the hard if their studies continue to pan out.

Why isn’t this a done deal? There are many questions with respect to breast augmentation with fat grafting. The following are just a few:

1. The results are not significantly different than non-stem cell fat grafting to the breast. I’ve done in the past on selected patients with good results. Dr. Coleman in New York and Dr. Khouri in Florida have achieved excellent results without stem cells. To date I don’t know of any study comparing stem cell fat grafting with non-stem cell fat grafting.
2. Caution needs to be used for the mastectomy reconstructions. In animal studies stem cells can potentiate cancer growth. Now there has already been a lot of work with fat grafting to breast cancer reconstruction. No problems have been reported. However is there a critical mass of stem cells that might cause a cancer recurrence?
3. What are the comparative costs going to be? Taking time to remove enough that can be a long procedure, adding to anesthesia expenses and increasing patient risk. As long as we’re taking out these cells and manipulating them why not have an ideal scenario where you take out 10 CC a fat in the office under local and grow to 1000 CC in the lab and then inject?
4. Who will be doing this? Anybody they can buy cytoris stem cell machine? Building a breast is an art as well as a science we’ve already seen the problems when non-core physicians, that is, family practitioners and gynecologists get into the plastic surgery profession.
5. There is currently a limit on how much fat can be put in. This is related to the skin tightness and pressure which kills fat grafts themselves when too much is put in. Dr. Khouri has solved this problem for now with skin expansion using the Brava bra but this is time-consuming and burdensome. If the cells are augmented with the Cytori stem cell technique can this be avoided?

So are stem cells really the answer to natural breast augmentation? Cytori is certainly betting a lot of money that it is. Hopefully their studies will show that stem cells and fat grafts will create an easy breast augmentation with minimal downtime and no future complications that is superior to current techniques. If not someone else will eventually come up with the answer. Tissue engineering is already here. It’s just not perfected. So stay tuned it’s going to be a wild ride!

- Press Release-

Research Reveals VASER Lipo® Yields Fat as Viable As Conventional Liposuction

LOUISVILLE, CO – According to a recent study conducted at the University of Pittsburgh, human fat harvested by VASER ultrasound-assisted liposuction (Sound Surgical Technologies LLC), is as viable as fat collected by conventional suction assisted liposuction, with nearly 80% volume retention.

The study, led by Dr. J. Peter Rubin, Associate Professor of Plastic Surgery at the University of Pittsburgh, is the first research to establish strong support for VASER Lipo as a collection method of choice for fat transfer procedures.

The study investigated tissue samples of a female subject who underwent lipoplasty of the thighs and flanks. Detailed cellular viability analysis was performed on tissues collected, each having undergone VASER Lipo and suction-assisted liposuction on the body area. The researchers found little or no difference at the cellular level between the treatments, concluding that VASER Lipo is just as effective in yielding viable fat cells as suction-assisted liposuction devices. Results at six weeks showed approximately 80% of the filtered fat survived by volume, regardless of the method of extraction. As a point of comparison, other studies have shown less than 5% of the water-jet assisted liposuction fat survived.

“The highly selective nature of ultrasound energy promotes increased fat viability, making it ideal for fat transfer procedures,” said Mark Schafer, Chief Technology Officer at Sound Surgical Technologies. “We believe this important research will pave the way for widespread adoption of VASER ultrasound-assisted liposuction as the preferred method for fat transfer.”

The study’s findings support recent physician feedback that the VASER Lipo System is the leading technology for fat harvesting and fat transfer procedures, with unrivaled body sculpting capabilities.

About VASER Lipo

The VASER Lipo System features gentle ultrasonic energy that uses sound waves to selectively target unwanted fat.  The FDA-cleared device uses small probes that emit ultrasound energy to gently break apart fatty tissue for easy removal without destroying the fat cells themselves.  This means physicians can immediately remove, harvest and re-inject the fat to contour and augment other parts of the body, including the face, hands, breasts and buttocks.  The VASER Lipo System, one of the most respected body contouring technologies on the market, is the cosmetic enhancement tool of choice among top physicians who have patients who want both of these procedures in one appointment.

About Sound Surgical Technologies

Founded in 1998, Sound Surgical Technologies is a leading manufacturer and distributor of ultrasonic body shaping technologies, including the VASER Lipo which effectively treats all areas of the body and is clinically proven to enhance skin retraction, reduce blood loss, and maintain the viability of fat cells for fat grafting procedures. Physicians report smooth and consistent results with fast patient recovery. The VASER Shape MC1 and MedSculpt Systemsare an ideal complement to VASER Lipo, combining ultrasound and massage therapies to increase lymphatic and venous circulation, minimize postoperative pain and swelling, and temporarily improve the appearance of cellulite. All of the devices are FDA-cleared for use in the U.S. To learn more, visit www.vaser.com.

Dr. Andrew Kaczynski took part in this study and is proud to offer VASER Lipo at Advanced Concepts in Plastic Surgery in Sacramento.

Lisa Rinna before her lip augmentation repair

Lisa Rinna is in the news again this time because she has had her lips fixed, i.e. reduced after a lip augmentation gone very wrong. Not coincidentally, this announcement comes at the same time that she is starting a new reality series with her husband called, “Harry Loves Lisa” on TV Land. Any publicity is good publicity especially since so much attention has been paid to her lips in the past. Her lips were always a topic of conversation. And why? I would suggest it is because she is a very attractive, vivacious woman with incredibly ugly lips. I’m sure at some point right after the injections they were attractive, but over time as always happens with silicone injections they changed into scarred distorted things. They looked like they belonged on a puffer fish. Lips like that have never naturally appeared on a human being since we appeared on the planet. Nevertheless, why did they look so bad? Because they simply did not look natural. Big lips are pretty when they are shaped well but not just because they are big.

If you look at the anatomy of beautiful lips you will see that:

1. There are three ovals in the upper lip.
2. There are two ovals in the lower lip.
3. The upper lip has three distinct parts.
4. The lower lip is always larger than the upper.
5. Lips are full not inflated six the central portion of lip actually hangs down little bit and is not concave.

Lip Augmentation at Advanced Concepts in Plastic Surgery

The worst thing about her lips is that she had silicone injections because she thought other fillers look good for a while, why not get something permanent. Well, there are actually a few problems with that line of thinking.

1. Silicone injections into the body or face, i.e., lips, are illegal.
2. They have always been illegal. In the past very few doctors had permission to use them experimentally in tiny amounts called microbe droplets, never for plumping up lips.
3. They are indeed permanent—permanent results and permanent complications.
4. The results of silicone may initially look good but will become scarred, irritated and filled with nodules of scar tissue causing the lips to appear bigger and odd shaped.
5. The only way she could fix this problem now is to have all the silicone cut out and that’s exactly what she had done. Her surgeon Garth Fisher actually did a very nice job of removing what silicone he could and reshaping the lips. She now looks normal and attractive and her lips complement her face very well, returning her natural beauty and symmetry. Removing the horizontal wedges and taking out as much silicone as he could has restored her symmetry. However, she isn’t out of the woods yet because there is likely silicone still in her lip because silicone migrates and moves. The only way to remove it completely is to remove the entire lip. I’ve actually had to deal with this with patients who had silicone injected into their breasts by other doctors. At some point in time when it gets bad enough the only treatment is total mastectomy and reconstruction.

So, what can you learn from this if you are considering lip augmentation?

Never gets silicone injections of any kind.

Ask to see examples of your doctor’s work. If he shows you a picture like, Donatella Brassard who looks like too bloated leeches are feasting horizontally on her face, then run.

Getting as much content as you can afford is not getting your money’s worth.

Balance and proportion creates beauty not bulk.

The search for beauty is pervasive and there are always unscrupulous people willing to take advantage of that. Do your homework on anything that you would have injected into your body.

Lisa Rinna Recently Had Her Lip Augmentation Reduced.

Plastic surgery is a part of celebrity culture today. From reality stars like Heidi Montag, Kim Kardashian, Pamela Anderson, and “The Real Housewives of…” to comedians like Joan Rivers and Kathy Griffin, to actors like Lisa Rinna, Nicole Kidman, Meg Ryan, Micky Rourke and of course stage performers like Cher and Kenny Rogers. All of these celebrities and hundreds more like them appear to have had cosmetic work done, and most, save Kim Kardashian and Cher, seem to have gone too far and pushed the limits of what plastic surgery is capable of.

The force behind this Hollywood celebrity trend to use plastic surgery beyond what is rational is a collective obsession with youthful perfection. That is, in American culture, youth is romanticized and physical perfection is idealized. The problem is that we are only young for a brief time in reality. Indeed, this evanescent quality is probably an ingredient of the fuel feeding this obsession. Combine this with the fact that very few, if any of us, are genetically perfect and you end up with a majority of the country somewhat unsatisfied with their appearance. Add to the fire, the pressure celebrities are under to be examples of perfection to those who consume their movies, TV shows, and music videos and you can imagine the desperate feelings these people have to hold on to this image of perfection or lose their celebrity status.

Further complicating the mix is that the personalities who go into that line of work tend to already enjoy some degree of narcissism with their coffee and you have a perfect storm. Nowhere do we see example after example of drastic measures taken by desperate souls to enhance or hold onto any shred of perfect youth that medical science might be able to offer. Likewise, nowhere else do we see so many sad cases of the fuel of this collective obsession with youthful perfection igniting the fire that ends in plastic surgery disasters.

As a plastic surgeon who believes very much that plastic surgery, and other cosmetic procedures such as Botox and facial fillers, can improve a person’s appearance and make them feel more confident, I cringe when I see the next star to step onto the red carpet with lips the size of sausages or faces pulled so tight they look like, as a friend of mine recently described, “a screaming skull.” Likewise, it sickens me to see a breast augmentation disaster such as putting 700cc breast implants in a petite woman of 5 foot 2 inches as was done to Heidi Montag, so she ends up making Barbie look comparatively proportional! These cases are not medical science being used to improve lives, they are a shameful mockery of the fine art of plastic surgery.

The most difficult thing for me to get my head around is the process by which a trained doctor goes through with these surgeries. If he or she is even remotely educated in plastic surgery, or even the pretend plastic surgeons who call themselves, “cosmetic surgeons,” these doctors have to know how awful these results are going to be before they even put the patient to sleep. As a plastic surgeon, my job is to improve on nature while balancing these improvements with aesthetic principles of balance, physical limits, and genetic realities. And a reality of being a plastic surgeon is knowing that some patients will come in with unrealistic expectations. I regularly have to sit down and explain in no uncertain terms, that there is such a thing as “too big” when it comes to breast implant size. It is very common for small framed women who have A-cup breasts to request breast implants that are simply going to make her look very top-heavy, cause stress damage to the skin, and create discomfort to the point that she will need to have them removed. When I explain the physical limits and the reality, most women normally understand and opt for smaller implants. In cases where they are still unconvinced and determined to have the larger implants, I apologize and tell them that as an ethical plastic surgeon, I cannot perform the surgery with the implants requested and we go our separate ways. And yes, occasionally they come back to me to have their “too large” implants removed.

I can feel for these plastic surgeons who have celebrities for patients. I can imagine they hear a lot of desperate stories about needing “that edge” in order to stay relevant in the fast paced world that is Hollywood, where one day you may be the toast of the town and the next you are wondering why you can’t even get an infomercial job. I realize there is tremendous pressure to push the limits because if you don’t someone else will. At the same time, we are doctors first and we have to do what is right by the patient, even if the patient is demanding what is wrong. We know that lips that look like two sausages painted red will look like hell, we know that 700cc implants can not be sustained in a petite woman of 5 foot 2 inches, we know that if you stretch the face back too far you will create a lizard mouth. We know this because it is what we do. Just as an engineer knows what you can and can’t do if you want a bridge to stay standing, a plane to stay in the sky or a computer to crunch ones and zeros and end up with me being able to type this article.

One thing I always stress with my patients is that when all is said and done, a stranger should never be able to look at you and “know” you’ve had plastic surgery. Whether it is breast augmentation, lip augmentation, a tummy tuck or a facelift, all should be subtle enough to look perfectly natural. Sure, if you go from an A-cup to a C-cup overnight, your friends might notice, but to the world, you should just look shapely, balanced and aesthetically pleasing to the eye, not like a freak of nature. Similarly, a facelift should simply take 10 to 15 years off your face, not make you look like a new person. You should look like pictures of yourself from the past. If you look at Joan Rivers now and Joan Rivers from 15 years ago, it is like they are two different people. On the other hand, if you look at Cher now and Cher 15 years ago, she looks the same! That’s plastic surgery done right!

The collective obsession with youthful perfection will probably be a part of the American cultural reality for the foreseeable future. Perhaps, just being a little more aware of it and reminding ourselves and our children to actively work toward being less influenced by it and more happy with our own realities is the answer. Sure, a good plastic surgeon can improve on nature a bit, fix some of the effects of time and make your day-to-day life a little happier because you smile more when you look in the mirror. But youthful perfection is not something we are capable of producing and someone needs to see that Hollywood gets the memo.