Kim Kardashian says she has only used Botox

Kim Kardashian, of Keeping Up with the Kardashians, admitted to using Botox, in an interview with ABC News show Nightline. However, she says she has not had a nose job or breast augmentation.

“Trust me honey, if I take this bra off you will tell me I need to get them done. I’m totally not against plastic surgery. … I’ve tried Botox before. That’s the only thing that I’ve done.”

Just the way she says that, I tend to believe her and while a great breast augmentation will look very natural, natural, can look natural as well!

However, Kim Kardashian’s sister, Courtney Kardashian says that she has had breast augmentation and seems to be very proud of it!

“I have had breast implants, but it’s so funny ’cause it’s not a secret, I could care less. It’s so funny because the ‘before’ picture that they [In Touch magazine] showed was after I had my boob job, so I’m like, they should have written ‘before Mason’ and ‘after Mason.’ Like my boobs have like tripled since breastfeeding.”

They go on to say that none of the Kardashians have had nose jobs and from looking at pictures on the Internet, even the “before and after” pictures that argue that she has, I tend to believe they haven’t. So much of what you see in those pictures can be explained by lighting and make-up. Kim Kardashian says that she actually did want to get her nose done but decided against it.

“But what’s funny is about my nose, it’s my biggest insecurity. I always want to get my nose done. … I went to a doctor, I had them take the pictures, he showed me what it would look like and it just didn’t– It– I wouldn’t look the same.”

I agree with Kim Kardashian here, if that is her natural nose, she does not need anything done to perfect it. If anything, there is more risk in changing it and it not looking as nice or as individual as it does naturally. Perfection doesn’t have to be generic, people all look different for a reason, plastic surgery is not about trying to make every face look perfectly the same, it is about enhancing what you do have or fixing issues that bother you. In Kim’s case, I would keep that nose, it looks great on her.

A refined Chelsea Clinton

A lot has been written lately about Chelsea Clinton and her recent wedding. The dresses, the schedule, the expense, the choreography of the wedding dance. All the little details our celebrity obsessed public thrives on and the media is happy to dish out 24 hours a day. There’s also been commentary about possible plastic surgery. Indeed if you look at photos of her growing up you can see that there are some changes. Most noticeably she seems to have had a chin implant and a correction of her somewhat gummy smile, probably with Botox.

So what’s the big deal? The media are always obsessed with celebrity plastic surgery. Mostly they discuss which celebrity is getting what plastic surgery and whether it is good, bad or ugly. In some cases, when it is good plastic surgery or you can’t quite tell whether the celebrity has had a nip/tuck or not and what they might be doing to maintain or enhance their appearance.

But for the vast number of people in the United States that have plastic surgery it’s not about beautiful people getting more beautiful or going to extreme lengths with plastic surgery in a desperate attempt to get that next big roll. It’s more often about people who just have a few details about their body or face that they’d like to change in an effort to be a little more confident about their physical appearance. One way to look at it is that we sort of work from the impression that there is a bell curve of appearance. We all want to be inside the bell curve ideally as far to the right of the top as possible, but most of us understand that that position is occupied by a few actors, actresses, supermodels and genetically blessed people. For the rest of us were content to be within two standard deviations of normal, whatever that is. The fact is that our brains are programmed to recognize attractiveness and symmetry as part of our genetic programming to search for a healthy mate. There is a correlation between attractiveness, health and lack of genetic diseases. So therefore we are programmed to recognize beauty and attractiveness, and instinctively know what falls within the bell curve. At the same time, we tend to assess our own placement on that bell curve and we often have little things that we consider changing in order to move ourselves just a little bit more toward the right. Now this can be complicated by various psychological issues of self-doubt or self worth but for most of us, we see ourselves fairly realistically and can make rational decisions about what plastic surgery might offer us.

Ah, the awkward teen years

Chelsea Clinton, as a teen, had a few challenges with her features and tended to look a bit awkward. Many teens experience an awkward phase as their features mature on the way to adulthood. As she has grown up and matured her looks  improved but she still had a receding chin and a rather “gummy” smile. With the plastic surgery that was performed, she successfully moved herself a standard deviation in the right direction of the bell curve. Her features look much more proportional and most would agree that she looked very pretty in her wedding photos.

So what does this have to do with the big picture? One of my staff members recently told me that before she started working for me she thought that plastic surgery was about bringing in a photo of your favorite movie star and having the surgeon make you look like that. That is absolutely not what plastic surgery is about. Plastic surgery is about restoring or improving balance, symmetry and aesthetic beauty. Like Chelsea Clinton, it is about fixing just a few of those little things that tend to make a positive difference. It’s about optimizing the attractive features that you have and balancing the rest. That is good plastic surgery. It worked for Chelsea Clinton!

Mazel tov!

The beaming bride, Chelsea Clinton on her wedding day.

Megan Fox Plastic Surgery Controversy

This time it’s Megan Fox - another, “does she or doesn’t she? Has she or hasn’t she?”  Unlike Heidi Montag’s obvious cosmetic surgeries, Megan Fox has a more refined look.  Megan Fox is a beautiful young woman by anyone’s standards – you don’t have to be a Transformers fan to enjoy that!  But, has she had some “refining”?  The beauty of good plastic surgery is that it is subtle, and it often begs the question, “Did she or didn’t she?”

As a plastic surgeon here in Sacramento, I get questions all the time as to whether I think this starlet or that celebrity has had cosmetic work done. One thing I often say is that pretty much everyone in that line of work has or will have something done to improve their appearance. Because Megan Fox has been in the news a lot lately, combined with the fact that she is one of the most beautiful starlets in Hollywood, I get asked about her a lot! If you look at pictures of Megan Fox on the Internet, you can come to several conclusions fairly quickly.  In my medical opinion, I believe I can spot a few procedures she’s undergone.  The important thing is that if she has undergone these procedures, they were performed very well so kudos to her doctor!

1. Megan Fox most definitely has had breast augmentation with breast implants. That’s fairly obvious even to a non-plastic surgeon, but her enhancement matches the rest of her figure, and it is not over the top literally like Heidi Montag’s breast augmentation.  It enhances her body without distracting from her other features.

2. She has also probably had two rhinoplasties.  The first rhinoplasty looks to be slightly unsuccessful.  There is an inverted V look on her upper nose in several photos that were taken after the bump was removed from her nose. This inverted V comes from the bones not coming together after being fractured. This was corrected the second time around, and further refinement appears to have been done on her nose, especially the tip.

3. Megan Fox likely has regular  Botox injections in her forehead. Even young people have some expression lines, but her forehead is incredibly clear without even a hint of a line. By using Botox at her age, she will avoid lines appearing in the future. She also seems to have had some shaping with advanced Botox techniques to raise a lateral and give her an exotic Angelina Jolie -type look.

4. Megan Fox also appears to have had a very good lip augmentation. Unlike many lip augmentations, Megan Fox’s lips are not over-the-top.  Her lips are definitely fuller, but it still looks relatively natural.

5. There has also been some suggestion of cheek implants, but unless they are very small, she just appears to have gotten older and a little more defined with some weight loss.

So what does this all mean?  It means that plastic surgery has something for everybody: for a middle-aged woman who wants to take in her neck a bit, or a young woman who wants a flatter stomach after having babies… or an aspiring superstar just shy of perfection. Were the changes reasonable?  I think she managed to fine tune her already attractive features and she did so without going way overboard like Heidi Montag. Is she more beautiful?  You can judge for yourself. But generally speaking a straight nose, fuller lips, a curved brow, and fuller breasts are often considered to be more attractive by our culture’s current standards of feminine beauty.

Facelift or filler, seems like an easy question. For the moment we will not address brow lifts and eyelid lifts. But the process to get the answer is fairly complicated.  As always it goes back to your anatomy.  If you look at your face there are many ways to diagram it or separate the parts.  One way is by skin adherence and mobility.  Around the mouth skin is adherent to the muscle, there isn’t much fat and there’s a lot of emotion in this area.  The rest of the face, cheek, jowels, and neck have a layer of fat between the skin and muscle and less adherence with less motion when we eat, talk or laugh.  But it does have more of a tendency to sag as we get older.  In addition one of the unfortunate aspects of aging for many people is a loss of facial fat.  No one really knows why it goes away.  It just does.  It seems to be related to declining hormone levels but all that still needs to be worked out.  Look at the photos of people in college, in mid life, and then when their old.  The loss of fat, the gaunt look is quite striking.  As an easy visual, think of Al Pacino in the Godfather and then again in his latest movie.

So we have two areas of the face by these criteria.  The central area just above and below the lips creates wrinkles from use and the lips themselves shrink.  Does lifting and pulling help any of this?  No.  What’s worse an ill-advised attempt at improving the lips by pulling (face lift) gives the widened stretched lizard lips sometimes seen in aging movie stars on late-night talk shows.  Lipstick lines, nasolabial folds, and the lips themselves are perfect for fillers which plump up and spackled these lines.  One exception to this rule is the tear trough area just under the eyes which can present as a darker circle but not a bank or a bulge but a hollow.  This area also responds very well to fillers.

On the other hand if there are jowls, multiple cheek wrinkles, and heavy nasolabial folds and neck issues, fat, hanging skin, muscle bands, then a facelift is the only way to go.  Fillers may help slightly with the nasolabial folds but by themselves cannot lift the jowls and neck.

Now that we know what a filler does, what is it?  There are many different kinds ranging from collagen to silicon to fat.  The most commonly used ones now are hyaluronic acid such as Juvederm and Restylane.  This is a natural component of our skin and was formerly obtained from rooster combs but is now available by being made by bacteria.  This substance which looks like a clear jelly is injected through a small syringe with a very small needle.  Depending upon the area, this can be done with no anesthesia, topical anesthesia or nerve blocks like a dentist.

Facelift or filler?  Look at the mirror what do you see?  Then see if your doctor agrees.