Every new technology is supposedly more effective and less invasive. I would like to make a boldstatement and say that not much has changed since Dr. Yves Illouz pioneered liposuction in the 1980’s,and that the new body contouring procedures are more hype than reality.

Liposuction is pretty much what you see on TV. The surgeon uses a cannula, or small pipe shapedobject, attached to a hose that sucks out the fat. Seems too simple and I guess that’s why people tendto market “improvements” to make the procedure seem better. Actually, there was one significantenhancement made a couple of decades ago. The original procedure was associated with a lot of bloodloss, up to 20% of the aspirate that was sucked out. Dr. Jeffrey Kline introduced the technique of puttinga very dilute saline solution with local anesthetic into the tissues prior to suctioning. This allowed thefat and saline to be sucked out with much less blood loss. This is called tumescent liposuction, and theblood loss is about 1-3% of the volume we suck out. Some have tried to confuse the issue by saying thatthey use the “wet”, “superwet”, and “ultrawet” techniques, but it all boils down to performing suctionwith dilute anesthetic solution infused into the tissues before suctioning.

In the late 1990’s until the current day, liposuction device manufacturers have tried to market adjuncttechnologies such as ultrasound and laser. It is claimed that by using sound or light energy, we can meltthe fat and have a better result. In my opinion, both the public and the plastic surgery community havebeen misled. In the hands of a skilled surgeon, you don’t need to “melt” fat to get a good result. A lessskilled surgeon may benefit from these, but I don’t know why someone would choose to get operatedon by a lesser surgeon. In fact, I have observed that seasoned liposuction surgeons are moving awayfrom such technologies as they add time to the procedure, and greater time in the OR means greaterrisk.

There is the belief among the general public that once you show signs of aging, its time to get a facelift.  In the latter part of the 20th century, this may have been true.  It was pretty much all we had at our disposal as plastic surgeons.  Fortunately, it’s not so simple anymore.  We have many more options for treating the aging face, and in my practice I have developed an entirely new approach.

There are 3 components to facial aging: gravitational descent of the soft tissues, loss of volume, and a general worsening of the quality of the skin.  Surgery can only take care of the first one.  When we were relying solely on the facelift to improve the aging face back in the 1970’s and 1980’s, we asking the procedure to do more than it was designed to do and consequently got some unnatural results.  I’m sure you can think of celebrities who have had exactly this outcome.

The ideal patient for surgery is someone who has jowls along the jaw line, excess skin and fatty accumulation in the neck and cheek pads that have descended from where they used to be.  These are structures that no amount of lasering or fillers can improve.  Modern facelift techniques last a long time, look natural, and are associated with quick recovery.  The goal is not to look different, but look like you did 10 years ago.

In 1962, the silicone breast implant first became available for breast volume augmentation. Despite caution in the medical community at the time, women flocked to plastic surgery offices to have their breasts enhanced. The new procedure allowed women to have fuller breasts that seemed to defy both gravity and the aging process. Breast enhancement became a rite of passage in some regions in the country, and had become commonplace among women in all walks of life by the 1980’s.

In the early 1990’s however, fears began to arise about a possible connection to a variety of diseases, including cancer, lupus, arthritis and other so-called autoimmune diseases. There wasn’t any specific rationale behind these concerns, but we simply didn’t know that much about the health consequences of silicone implants. This led the FDA to impose a virtual ban on the use of silicone breast implants in 1992. Incidentally, this ban did not extend to the use of silicone in facial and orthopedic implants and a whole host of other medical and consumer products.

"Increased regulation and consumer concerns about Accutane and its side effects are making light treatments for acne increasingly popular among both physicians an patients," says Patrick Bitter, Jr., MD, Beverly Hills and Los Gatos, California. Concerns about Accutane and birth defects led to the iPLEDGE registry.

July 18, 2007 - Choosing the right plastic surgeon, one with the appropriate mix of artistic aptitude, experience and the credentials to back them up can prove to be quite a challenge. Throw in a mix of board certifications (or not), association memberships (or the absence of any) and word-of-mouth references from gal-pals you think are fun but know aren’t as particular as you are, and you’ve got an overwhelming decision to make. Sorting through the white noise and the marketing hits you get every day through direct mail, email, newspapers, magazines, TV and radio, plus the internet, not to mention the input from so-called friends when you confess to them you want to do something to improve your looks, is challenging. The anonymous marketing that media can be and the impassioned feedback from your girlfriends that you are looking good and “don’t need a thing done,” rattle around in your head like a pinball loose in play.

What’s a woman to do to narrow down her decision of whether cosmetic surgery is the right decision and who is the right doctor to perform that surgery?